Muhammad Yousaf, M A Hosny.
Small Bowel Obstruction after Laparoscopic Inguinal Hernia Repair.
J Coll Physicians Surg Pak Jan ;11(11):721-2.

Laparoscopic / minimal access surgery has revolutionised the management of some surgical diseases. In general surgery laparoscopic cholecystectomy has been a great success. With increased experience and better equipment, many operations are being performed laparoscopically including surgery for inguinal hernia. However, this modality of surgery is not without complications. In comparison open surgery for inguinal hernia is time tested with fewer serious complications. This is a case report in which laparoscopic transabdominal repair of inguinal hernia resulted in intestinal obstruction.

Case Report: A 54-year-old man was admitted for elective laparoscopic repair of a left inguinoscrotal hernia. He had a past history of appendicectomy. Laparoscopy demonstrated a left sliding inguinoscrotal hernia. Minimal adhesions were noted between the greater omentum and the appendicectomy scar. A standard threeport technique was used and a transabdominal pre-peritoneal hernioplasty performed. The patient made an uneventful recovery and was discharged home the next morning. On the 4th postoperative day he was re-admitted with signs and symptoms of small bowel obstruction. Initially, he was managed conservatively and he responded well to this treatment but his symptoms of abdominal distension and pain returned after 48 hours. He continued to have intermittent small bowel obstruction confirmed by abdominal x-ray. On the 7th day of admission, he developed high-grade fever, tachycardia, rigors, leucocytosis and hyperbilirubinemia with elevated liver enzymes. Abdominal examination revealed mildly distended and tender abdomen and increased bowel sounds. An abdominal ultrasound demonstrated features of acute cholecystitis in addition to dilated loops of small bowel.

At this stage a second laparoscopy was performed, which showed the terminal ileum herniating into the old appendicectomy scar, with dilated proximal small bowel. The site of the hernioplasty was intact with adherent omentum only. The gallbladder was distended and edematous. Unsuccessful attempts were made to reduce the herniating ileum. Thereafter the previous appendicectomy scar was opened and the small bowel delivered through the wound. There was an acutely kinked and discoloured segment with dilated proximal bowel. A small bowel resection and anastomosis was performed and the patient made an uneventful recovery.

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