Laparoscopic treatment of obstructed internal supravesical hernia: A cases series and rewiev of the literature

Introduction: internal supravesical hernia (ISH) is an exceptional subtype of internal hernia often presenting with small bowel obstruction (SBO). Its rarity makes preoperative suspicion and diagnosis very difficult in an emergency setting. Methods: we retrospectively analyzed the database of patients admitted in a single center emergency unit for small bowel occlusion (SBO) in virgin abdomen and treated by surgery from August 2013 to October 2018. The patients with intraoperative diagnosis of ISH were included in this study. Results: from 29 patients with virgin abdomen submitted to surgery for SBO, two cases of ISH were recorded. In both cases preoperative diagnosis was made by CT scan and urgent treatment was successfully performed by laparoscopy, reducing the entrapped small bowel and closing the hernia's ring by continuous suture. No intestinal resection was needed. Discussion: urgent laparotomic repair of obstructive ISH is the standard treatment although laparoscopic approach has also been described in a small number of cases. We reported our experience on two cases in which totally laparoscopic treatment was successfully performed in patients with stable hemodynamic parameters thanks to early diagnosis and limited intestinal distension. By an extensive analysis of the international literature, clinical, diagnostic and therapeutic aspects of this form of internal hernia were discussed. Conclusion: CT scan facilitates early ISH preoperative diagnosis, reducing the risk of small bowel resection and increasing the chances of minimally invasive laparoscopic treatment.