Laparoscopy in the evaluation of the incarcerated mass in groin hernia

Background: In hernia patients, the preoperative diagnosis of strangulation is difficult. In this prospective study, we investigated the usefulness of an exploratory laparoscopy to evaluate the viability of a viscus incarcera ted in a groin hernia. Methods: Twenty-seven patients with an acute irreducible inguinal mass unde rwent exploratory laparoscopy. The hernia was reduced, and the viability of the incarcerated viscus was judged laparoscopically on the basis of color, congestion, and contractility. Results: Twenty-four hernias were found. In sixteen patients, the contents of the hernia were viable. In five patients, a necrotic bowel segment was f ound, and a laparotomy and resection were done. In three patients, no herni as were found. The cause of inguinal pain was spermatic cord hematoma in on e patient and inguinal abscess in another; however, the cause of pain in th e third patient remained unclear. After laparotomy, one patient developed a fascial rupture that required reoperation. There were no other complicatio ns. Conclusion: At laparoscopy, the judgment of the viability of the contents o f the hernia is similar to that at laparotomy. The early use of laparoscopy can prevent many unnecessary laparotomies.