De Garengeot's hernia patients entirely treated laparoscopically: a safe and feasible alternative-a systematic review.

PURPOSE: Less than 450 cases of femoral hernias containing the vermiform appendix have been published since De Garengeot's first description. A laparoscopic treatment option opened 15 years ago seems reliable and safe. A literature review of all the patients who have benefited from this new therapeutic alternative is presented. METHODS: A systematic review using the German Society of Surgery's recommendations was performed for De Garengeot's hernias totally treated laparoscopically. Keywords searched included "De Garengeot hernia" OR "femoral hernia appendix" OR "crural hernia appendix." RESULTS: Only 29 out of 225 De Garengeot hernia's manuscripts were identified describing patients entirely treated laparoscopically: 25 patients by a transabdominal preperitoneal hernia repair (TAPP) and 4 patients by a total extraperitoneal (TEP) procedure; 85.1% were females. The mean age was 71 years. Twenty-two patients had pre-operative imaging tests, sonography (2), computed tomography (14), or both (6). Nevertheless, only 56% had a preoperative diagnosis. Twenty-one cases required urgent treatment, while programmed surgery was possible in 7 instances. An appendix-sparing procedure could be done in 16% of the TAPPs. No postoperative complications occurred. The median hospital stay was 2.5 days. CONCLUSIONS: The best surgical approach for a De Garengeot's hernia is not defined, and many critical questions remain unanswered. A better understanding of the diagnosis and treatment of this peculiar hernia will supply guidelines for clinicians who may encounter it hereafter. A fully laparoscopic approach seems perfectly safe and feasible for this entity, and it could be considered the first-line alternative if enough expertise is available.

Appendix-sparing laparoscopic transabdominal preperitoneal hernioplasty for a De Garengeot's hernia. A new case report and review of the literature.

Introduction and importance: More than 600 cases of De Garengeot's hernia, characterized by a femoral hernia containing the vermiform appendix, have been reported. The surgical method of choice has been an appendectomy and a primary hernia repair. Since the emergence of laparoscopy, this is undoubtedly an option. However, the treatment of the appendix remains in most reports as an appendectomy. Successful appendix-sparing treatment of De Garengeot's hernia via laparotomy or laparoscopy has been described, mainly since the COVID-19 pandemic. Case presentation: We report a new case of an 80-year-old woman with an incarcerated De Garengeot's appendiceal femoral-crural hernia, successfully treated entirely laparoscopically. She had noticed the protrusion of a lump in her right inguinal region for two months. Radiological studies, ultrasonography (US), and computed tomography (CT) were inconclusive. Due to the failure in the preoperative diagnosis, a minimally invasive endoscopic approach was performed. Although the distal appendix appeared incarcerated in the femoral ring, there was no evidence of appendicitis. Thus, a fully laparoscopic appendix-sparing transabdominal preperitoneal (TAPP) hernioplasty procedure was undertaken. The patient made an uninterrupted recovery. She did well postoperatively with no complications, left the hospital the same day in a stable condition, returned to complete activities, and has enjoyed good health since. Clinical Discussion: Our literature review shows that in selected cases an appendectomy may be safely avoided, eliminating appendectomy-associated morbidity, and could be considered the first-line alternative when expertise is available. Conclusion: A fully laparoscopic appendix-sparing TAPP approach seems safe and feasible to treat this entity.

Appendix-Sparing Transabdominal Preperitoneal Laparoscopic Hernioplasty for a De Garengeot's Hernia: Video Demonstration.

Background and Objectives: Less than 300 cases of a De Garengeot's hernia have been published. This rare femoral hernia with the vermiform appendix included appears almost exclusively on the right side, mainly in females, and it generally debuts as an incarcerated femoral hernia. Although most of the times there is a concomitant appendicitis, clinical signs of peritonitis are absent. The wide use of radiologic exams has not favored its preoperative diagnosis, but been usually found incidentally during a surgical emergency. The best surgical approach to a De Garengeot's hernia is not totally defined and many critical questions still remain unanswered. Open surgery is considered the standard treatment procedure, but since the emergence of laparoscopy for incarcerated hernias, this is certainly an option. Methods: We report the successful laparoscopic management of an 83-year-old woman who had been operated on her right inguinal hernia, with a Rutkow-Robbins' technique, 4 months earlier. She had noticed the protrusion of a lump in her right inguinal region for 2 months. Radiological studies were not conclusive. With a miss diagnosis of a recurrent incarcerated inguinal hernia, a minimal invasive endoscopic approach was performed. A representative case of this fully laparoscopic TAPP procedure is presented. Results: The patient made an uninterrupted recovery. She left the hospital the day after in a stable condition and has enjoyed good health since. Conclusion: A fully laparoscopic TAPP approach seems perfectly safe and feasible to treat this entity, and could be considered the first line alternative when enough expertise is available.