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. 2022 Jul:96:107335.
doi: 10.1016/j.ijscr.2022.107335. Epub 2022 Jun 22.

A novel laparoscopic non-resective technique for the management of strangulated Richter's hernia

Marleny Carmona  1 , Eduardo Smith Singares  2
Affiliations

A novel laparoscopic non-resective technique for the management of strangulated Richter's hernia

Marleny Carmona et al. Int J Surg Case Rep. 2022 Jul.

Abstract
in Uzbek, Uzbek

Introduction and importance: The incidence of Richter's hernias has risen in part due to the increment use of laparoscopic surgery. The standard technique to manage a strangulated Richter's hernia is bowel resection with anastomosis. Alternatively, invagination of the necrotic area in the enterocele maintains a clean surgical field and allows for the use of a mesh when closing the abdominal wall. In a sterile surgical field, the use of a prosthetic reinforcement has shown advantages, including low rates of long-term complications and reduced rates of hernia recurrence.

Case presentation: A 35-year-old male presented with a strangulated Richter's hernia in a periumbilical abdominal wall defect. In the Operating Theatre, the necrotic segment was managed laparoscopically by plication with invagination allowing for abdominal wall reconstruction with a mesh.

Clinical discussion and conclusion: We propose the laparoscopic repair of Richter's hernia with plication and invagination whenever feasible, therefore avoiding a bowel resection and maintaining a clean surgical field; which allows for use of prosthetic mesh.

  1. •

    Richter hernias are becoming more common, mostly as a result of port-site closure defects after laparoscopic surgery

  2. •

    Avoiding bowel resection will increase the likelihood of a successful long-term mesh implant and decrease hernia recurrences.

  3. •

    Likewise, avoiding a bowel anastomosis will prevent additional contamination while simplifying the procedure.

Keywords: Case report; Enteroplication; Laparoscopic non-resective technique; Partial enterocele; Richter's hernia.

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Conflict of interest statement

The authors (MC and ESS) declare that they have no conflict of interest pertaining to this case report.

Figures

Fig. 1
Fig. 1
A and B: Computed Tomography scans of the abdomen (axial and sagittal cuts) demonstrating a hernia.
Fig. 2
Fig. 2
Intraoperative images of the Richter hernia and the process of its invagination. A) Ischemia of the previously incarcerated small bowel. B-D) The invagination process of the Richter hernia by plicating the surrounding healthy serosa of the bowel with multiple interrupted sutures (Lembert-style) of 3-0 silk.
See this image and copyright information in PMC

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