Hernia Sac Laparoscopy under Spinal Anesthesia for Evaluation of Reduced Incarcerated Inguinal Hernia

Hernia sac laparoscopy (laparoscopy through an inguinal hernia sac) is a useful method to evaluate the viability of the self-reduced bowel of incarcerated inguinal hernia that is suspected for strangulation, and avoid unnecessary exploratory laparotomy. On the other hand, peritoneal insufflation for laparoscopy is best avoided in patients with severe chronic obstructive pulmonary disease or poor cardiac output. Here, we describe a 78-year-old male with chronic obstructive pulmonary disease and congestive heart failure, whose incarcerated inguinal hernia self-reduced when he was given spinal anesthesia. Bowel viability was in question, so hernia sac laparoscopy without gas was performed, which allowed us adequate evaluation of the reduced bowel by positioning alone, avoiding both exploratory laparotomy and peritoneal insufflation. In our case, hernia sac laparoscopy under spinal anesthesia without pneumoperitoneum was sufficient to obtain necessary information with minimal surgical stress. This paper was presented at Society of American Gastrointestinal Endoscopic Surgeons 2006 Annual Meeting.