Laparoscopic Management of Non-Viable Bowel Following Reduction en masse

We read with interest the technical note explaining laparoscopic assessment of bowel viability following reduction en masse. However, the article did not make any suggestion of management strategy for non-viable bowel following reduction en masse. Following our recent experience of this, we would like to recommend a management approach in this situation.

We performed an open inguinal hernia repair for a gentleman presenting with an incarcerated inguinal hernia. Reduction en masse occurred peri-operatively; we opened the hernia sac and inserted a 12-mm Excel laparoscopic port (Ethicon) into the abdominal cavity. Following induction of a pneunioperitoneuni, we found 14 cm of non-viable small bowel. We inserted a second 12-mm laparoscopic umbilical port and, using a laparoscopic Babcock, grasped the section of non-viable small bowel. Following hernioplasty, we extended the umbilical port to approximately 4 cm and delivered the small bowel, resecting the necrotic segment.

This laparoscopic-assisted, small bowel resection saved the patient a full laparotomy and expedited his postoperative recovery. By performing the small bowel resection through the extended umbilical port site, we prevented contamination of the hernia repair. This technique offers an innovative, and less invasive, method of managing non-viable small bowel following reduction en masse.