Rafique Umer Harvitkar
Royal Australasian College of Surgeons, United KingdomTitle: Occult hernia: role of laparoscopy in detecting the unseen - a case series with review of literature
Abstract
INTRODUCTION: Occult hernias(OH) refer to those hernias which are not evident on clinical examination, but which are noted either on surgical exploration or on good quality pre-operative imaging. Identifying them in day-to-day practice is of immense importance in view of unexplained and undiagnosed symptomatology, post-operative recurrences and cost effectiveness. In this retrospective study of patients who underwent laparoscopic groin hernia surgery over the last 13 years in our institute, we attempt to decipher the burden of occult herniae and various other associated factors.
OBJECTIVE: The main objective of this paper is to study the incidence of occult hernias diagnosed intra-operatively during laparoscopic groin hernia surgery. We also intend to study the incidence of different types of occult herniae characterised on the basis of side (unilateral / bilateral, ipsilateral / contralateral, right sided - ipsilateral and contralateral vs left sided -ipsilateral and contralateral), location (inguinal, femoral, spigelian etc.) and type (direct vs indirect inguinal).
PATIENTS AND METHODS: In this retrospective study, we identified 723 patients who underwent laparoscopic repair of groin hernia in our institute by a single surgeon, from 2008 to 2021. Out of these, 664 underwent a laparoscopic totally extra-peritoneal groin hernia repair (TEPA) and 59 underwent a laparoscopic trans-abdominal pre-peritoneal groin hernia repair(TAPP). OH were found in 120 patients, all during TEPA and none during TAPP. The age range of these 120 patients was 22 to 83 years (mean : 60.7 years with SD : +/- 12.5 years). The patients were also analysed for sex, type of OH, side of OH and post-operative outcomes.
RESULTS: Incidence of OH in our study was 16.59% (120 out of 723 patients). OH were found in both male as well as female patients. These comprised of unilateral and bilateral OH. Patients with unilateral OH heavily outnumbered those with bilateral OH (n=117 vs 3). In relation to the side of the clinically discernible hernia, the unilateral OH were either ipsilateral or contralateral. There were 3 different types of OH in our study – inguinal, femoral and spigelian. The maximum number of cases were of inguinal OH (n=115). Among inguinal OH, patients with direct OH outnumbered those with indirect OH (n=73 vs 40).
CONCLUSION: Awareness about OH as an entity is important, as their identification and concurrent repair possibly spares the patient another surgical intervention at a later date.
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