Network meta-analysis as a tool in clinical practice guidelines.

Aims Spleen malignancies can be treated by laparoscopic approach with oncologic safety even in presence of splenomegaly. Methods: We present a video of a laparoscopic splenectomy and hepatic biopsy in a 55-year-old female with Spleen Lymphoma with splenomegaly. Results: Laparoscopic splenectomy with spleen extraction by a Pfannenstiel incision was performed without complications, and with a short hospital stay. Pathological exam confirmed the presence of a B Lymphoma with liver involvement. The patient keeps on chemotherapy. Conclusions: Laparoscopic splenectomy is a feasible and safe in oncologic diseases with splenomegaly

Aim: Our aim is to describe the minimally invasive surgical management of Dunbar syndrome. Methods: Dunbar syndrome, which is also referred to as celiac axis compression syndrome, is a rare condition. The screening can be performed with duplex doppler ultrasound, which shows a peak flow higher than normal but may not clearly identify the cause of compression. The diagnosis is performed with CT examination, best noted on sagittal views. The patient, a 55-year-old female, presented to the emergency department with post-prandial colicky pain, nausea and vomiting, performed an abdominal CT-scan, which evidenced the sign of the median arcuate ligament (MAL), inserted below the T12, compressing upon the proximal tract of the celiac trunk. Symptomatic treatment of the pain and PPI were prescribed without clear benefit. Three years after diagnosis, still complaining symptoms, she was referred to our Surgical Department. A CT angiography was performed and confirmed the indication to surgical intervention through laparoscopic debridement of the celiac trunk and section of the MAL. Pneumoperitoneum was achieved through open-Veress-assisted technique and four trocars were introduced through the abdominal wall. The epatoduodenal ligament was identified and sectioned in its pars flaccida through a cordless ultrasonic dissection device. The right diaphragmatic pillar was followed on its medial margin up to the MAL. On the aortic plane the origin of the celiac trunk was detected, and the lysis of the MAL’s fibers was completed. Results: The operative time was 30 min. Post-operative course has been regular. Right after surgery, the patient was able to move from bed, was fed with semi-liquid diet since two hours after and was discharged during the second post-operative day. At 30 days follow-up, the patient did not complain gastrointestinal symptoms and was following a regular diet. Conclusions: Endovascular treatment is possible, but surgery is the preferred treatment of Dunbar syndrome. Laparoscopic minimally invasive approach is safe, feasible and effective. It should be preferred over open surgery, when possible, and must be performed by experienced surgeons in order to reduce the risk of incomplete treatment and recurrence.

Aims: Laparoscopic surgery is the best approach to acute abdomen since it can provide inspection to the entire abdominal cavity. This video aims to present a case of Perforated Peptic ulcer. Methods: A 65 years-old woman presented at Emergency Department complaining of severe pain in Right Upper Abdominal Quadrant. A Abdominal ultrasound and blood tests were performed and the diagnosis of Acute Cholecystitis was made. A Laparoscopic Cholecystectomy was proposed. Results: When laparoscopy was started, no signs of gallbladder inflammation were presented and biliary peritonitis was presented due to a perforated Peptic Ulcer. A laparoscopic suture was made. The post operative period was uneventful. Conclusion: Laparoscopic approach to abdominal emergencies should always be presented as it can provide the right treatment in an unexpected situation.

Aim: In 2017, two of our Upper Gastrointestinal (GI) surgeons in our centre performed the first robotic Gastrointestinal Stromal Tumours (GIST) excision in the United Kingdom successfully. The patient was discharged 5 days later after an uneventful recovery. Our site has been involved in removing GISTs for over 10 years. With the surgical advancements, our techniques have upgraded from open to laparoscopic to robotic. GISTs can arise in inconvenient locations (cardia, pylorus) and in different sizes. With the development of robotic surgery, the DaVinci robot has allowed the surgeon to perform precise wedge resection with high definition 3D visualisation and instruments with endowrist technology. This is all completed with the comfort and protection of the surgeon’s musculoskeletal system. This study was to see the changes in Length of Stay (LoS) with the advancement of technology. Methods: Data of the cases were collected retrospectively from 2011–2021. The database comprised of open, laparoscopic and robotic cases amongst 5 surgeons. Cases where notes were unavailable were removed from data collection. Length of Stay (LoS) was statistically assessed using Mann–Whitney U test on SPSS v22. Results: From 2011- 2021, we have completed 88 GIST resection cases. 19 (22%) cases were open, 61(69%) cases were laparoscopic and 8 (9%) cases were robotic. The median age of the patients were 59 years (ranging 48–82 years). The median length of stay for Open was 9 days (5–19 days), for laparoscopic it was 7 days (5–12 days) and for robotic 5 days (2–9 days). Our data suggested significant results comparing LoS between the 3 groups. Tumour negative margins were noted in all cases reviewed. Complementary table attached to show p-values. Conclusion: Our current data trends show that as technology advances, there is a significant reduction in the total LoS in both ITU and the complete hospital admission. In addition, our robotic surgery data suggests increased success in removal of GIST tumours from challenging anatomical locations. This effectively reduces the requirement of formal major resection and reconstruction and ops for a wedge resection which subsequently reduces the need for HDU admission and improves functional outcome.

Laparoscopic appendectomy (LA) appears to have distinct advantages over open appendectomy. The laparoscopic procedures produce less pain, allow more rapid return to full activities, are associated with lower incidence of wound infection, fewer postoperative complications, better intraabdominal exploration and require shorter hospital stays. Previously, the only disadvantage to the laparoscopic approach was slightly increased operative time, however, nowadays with the increased laparoscopic training programs and the experts’ hands, LA takes less operative time. On one hand, the first Conventional method of port insertion for laparoscopic appendectomy often result in difficult surgical access, particularly as the third port is inserted in the Rt iliac fossa. In addition, after the procedure there will be two apparent scars, one in the left iliac fossa and other in the Rt iliac fossa.. Adding to this, when a retrocecal appendix is encountered or when mobilization of the caecum becomes necessary, ergonomically it will be difficult to be done through the conventional port positions. On the other hand, in the second common method, where a port is inserted in the supra pubic area and the other port is inserted in the left iliac fossa, although it gives the surgeon better access, however, there is still one apparent scar in the left iliac fossa. Moreover, inserting the telescope in the umbilicus does not give a proper view for the cecum and the retrocecal area. In our study, one port will be in the umbilicus, the physiological scar of the abdomen, and the two remaining ports will be inserted in bikini line. Therefore, in our approach, there will be no apparent scars, as a result, this will be much more satisfactory for the patients due to the better cosmetic Results: Furthermore, in our study we have inserted the telescope in the left port in the bikini line and the main working hand in the umbilicus. what we have found that, ergonomically we have achieved the best access as the telescope now is between the two instruments, therefore the two azimuths angles are equally and the manipulation angle is almost 70 degrees. Adding to this, inserting the telescope in the left mid inguinal point has offered the best vision for the caecum and the retrocecal area and we now we are able to dissect the ascending colon easily. To conclude, our new technique has delivered, not only the best cosmetic outcome, but also brilliant ergonomics compared to the previous conventional Methods. On top of that, our new technique was not ceased by any specific gender, age, height, TLC count, a particular appendicular position or the presence of appendicular mass or Abscess. Therefore, it could be said that Bikini line laparoscopic appendectomy has to become the standard technique for appendectomy.

54 year old gentleman a known case of Ulcerative Colitis since 2009. Surveillance colonoscopy showed a low rectal lesion 4 cm from the anal verge (figure 1). Biopsy revealed high grade dysplasia. he underwent Laparoscopic proctocolectomy with ileal pouch anal anastomosis. The histopathology of the resected specimen at the time showed no malignancy and benign lymph nodes (0/19). Three months later patient had burning anal pain and diarrhoea for which he underwent sigmoidoscopy that showed severe ulceration at the pouch outlet (figure 2). Biopsy showed high grade dysplasia. The patient underwent transanal mucosectomy on the remnant rectal mucosa with a histopathology of (pTispNx) Following the procedure, the patient had another sigmoidoscopy and biopsy that showed invasive adenocarcinoma. His case was discussed in our GI MDT and a decision for an abdominoperineal resection with total ileoanal pouch excision was made The procedure was done robotically and was started with adhesiolysis and freeing of the ileoanal pouch The pouch was then dissected freely up to to the pelvic floor. Then resection of the anorectal stump was carried out transperineally. An End ileostomy was fashioned on the left side of the abdomen due to the presence of parastomal hernia at the previous diverting loop ileostomy site for the initial IPAA procedure. Patient had a smooth postop recovery and was discharged on postop day 7.

Aims: The aim of this presentation is to describe the feasibility and the tecnical robotic approach to an esophytic lesion located in the pancreatic head, in a young patient. Methods: We show a clinical case of patient of 30 years old, that during the routine ecotomografy discovered a lesion of 25 × 24 mm located in the pancreas head. she submitted to total body tc and mri that confirmed the only one lesion. moreover dotatoc pet demonstrated high captation nearby the nodule (suv: 40,6). considering the only one lesion, the young age of the patient and the high comorbidity related to pancreato-duodenectomy, after the multidisciplinary consuling, we decided for robotic enucleo resection of lesion. Result: The patient was discharged on 5th post operative day, without postoperative complications. hystologic exam confirmed pancreatic net g1. at 48 months from surgery the patient was disease free. Conclusion: Robotic enucleoresection of lesion located in pancreatic head is a feasible possibility of approach in selected case to avoid pancreatoduodenectomy.

A 34 years old female patient is a known case of inflammatory bowel disease Crohn’s disease since 10 years with initial presentation of watery diarrhea, abdominal pain & distention, with decrease in body weight, managed conservatively and kept on pentasa. Her medical condition was complicated by multiple attacks of crohn's disease exacerbation, colonic perforation, subcutaneous abscess, and enterocutatnous fistula. As part of her management, the patient underwent ileocecectomy done with end to end ileocolic anastomosis which was later on complicated by an abscess collection at the site of laparotmy scar, and enterocutatnous fistula, with the cutatnous opening being the middle of the laparotomy scar. Embolization with Glu injection and coiling was done for the fistula which showed an excellent result.

Background: Iatrogenic colon perforation (ICP) is one of the complications associated with colonoscopy which can lead to fatal outcomes such as peritonitis and sepsis. The lack of literature regarding complete transection of colon renders this case report of great value. Case presentation: A 75 years old lady, underwent elective colonoscopy for diagnostic purposes. During the procedure, her condition deteriorated and she developed abdominal pain and destination. Erect CXR showed air under the diaphragm suggestive of perforated viscus (Fig. 1). Therefore, laparoscopic exploration was carried out, massive pneumoperitoneum with purulent peritonitis was found, and the sigmoid colon was found completely transected (Fig. 2). The two loops were exteriorized as a stoma, and a pelvic drain was inserted. The patient was discharged on day 16 postoperatively, in a good condition. The stoma was reversed 8 weeks postoperatively with no further complications. Discussion: The reported cases of Iatrogenic Colonic Perforation (ICP) associated with colonoscopy are usually limited to a small sized perforation. Here, we are reporting the first case _according to our knowledge_ of iatrogenic complete transection of the colon. Furthermore, the case was managed successfully via laparoscopic approach. Conclusion: Complete transection of the colon could be considered as one of the iatrogenic complications associated with colonoscopy. Moreover, the laparoscopic approach showed optimal outcomes.

Background: Open approach for emergency operations are still widely adopted. Open management might be influenced by patient’s physiological status, co-morbidities, previous abdominal surgery, presence of bowel obstruction, equipment availability and the surgical expertise. Aims: To highlight that minimally invasive surgery (MIS) in the acute setting is a good opportunity for supervised training and if widely adopted can offer great advantages to both patient and surgical trainee. Methods: A 92y female presented with acute small bowel obstruction and severe dehydration and electrolyte disturbance. Her previous surgical history included a transabdominal hysterectomy through a left paramedian incision. IV fluid resuscitation and electrolyte correction was initiated along with NGT and urinary catheter. CT scan confirmed the diagnosis of small bowel obstruction at the level of the mid-ileum due to impacted gallstone 2.4 cm. Results: After adequate resuscitation patient was taken to theatre for a laparoscopic operation. Pneumoperitoneum was established with a Veres needle on the left upper quadrant. This point was decided preoperatively after studying CT imaging. One 11 mm and two 5 mm ports were used, 30degree scope was used. The greater omentum was adherent to the abdominal wall along the previous incision and it was dissected. The collapsed distal small bowel was examined starting from the ileo-caecal junction and traced proximally until the impacted gall stone was identified, Videne soaked swab was placed intra abdominally in case any bowel content spilled. A laparoscopic retrieval bag was positioned in the abdomen ready to place the extracted stone. The bowel was opened longitudinally, the stone was extracted and secured in a retrieval bag and the enterotomy was closed transversely with a running absorbable barbed suture (V-lock 3-0) in two layers. The first layer was performed by the trainee and the second layer was performed by the supervising consultant. The stone was removed after being crushed successfully inside the bag to minimise wound extension. The patient had slow uneventful post op recovery due to expected ileus. Her post op recovery and early mobilisation was great demonstration of the advantage of MIS approach Conclusion: Bowel obstruction and previous abdominal surgery are not contra-indication for emergency laparoscopic approach. Pre-operative resuscitation, preparation, planning, and communication to facilitate holistic approach are essential in high-risk patient. From the trainee’s perspective, operations that involve intracorporeal suturing are usually more challenging and this might be a common reason to opt for open approach. This might adversely affect the patients’ good outcomes and deprive them from the possible advantages of MIS. Offering this option will enhance surgical training and prepare future consultant to be more competent and therefore more confident to proceed laparoscopically in more emergency cases.

Aims: The feasibility and safety of laparoscopic surgery in T4 colon cancer have been evaluated in many studies and found to have acceptable oncological outcomes. However, laparoscopic resection for T4 tumours is technically challenging and needs expertise in laparoscopic surgery. In this video, we demonstrate stepwise Laparoscopic resection for T4 Sigmoid cancer. Methods This is a single case video demonstration of laparoscopic resection for a T4 sigmoid tumour. A 48-year-old patient was evaluated for pain in the abdomen. Colonoscopy showed growth at 40 cm and biopsy revealed moderately differentiated adenocarcinoma. The CECT scan was suggestive of a non-metastatic bulky sigmoid lesion abutting the urinary bladder, involving lateral abdominal wall. Results: This is stepwise demonstration of resection of bulky T4 sigmoid lesion involving bladder and lateral abdominal wall. Proper surgical planning and its execution help to avoid conversion.The introperative and postoperative course was uneventful. The final histopathology revealed a pT4N0 moderately differentiated adenocarcinoma with free margins. Conclusion In this video, we have shown a step-wise approach to laparoscopic resection for T4 sigmoid colon cancer. Laparoscopic T4 colonic cancer surgery is technically challenging but should not be a reason for conversion.

Background: Mandatory pre-operative weight loss is often required as admissibility criteria for bariatric surgery. Some authors propose that pre-operative weight loss is associated with patient compliance to dietary and lifestyle interventions, which are paramount in the management of obesity. However, there is no hard evidence confirming that pre-operative weight loss is related to the magnitude of post-operative weight loss. On the other hand, refusing bariatric surgery to patients who are unable to lose weight pre-operatively might exclude patients who need the most the surgically induced weight loss. Aims: In this preliminary study we try to analyze if pre-operative weight change is associated with post-operative weight loss after bariatric surgery. Methods: Retrospective analysis of 198 patients treated in a Portuguese Community Hospital between January 2018 and September 2021. Statistical analysis was performed with SPSS v. 28 and p-values < 0.05 were considered significant. Patients were analyzed regarding anthropometric data, weight change between the first outpatient visit and the day of the surgery and post-operative weight change. Results: Most patients were female. The mean BMI was 43.1 kg/m 2 . The most frequent surgery was gastric bypass (56.6%) followed by gastric sleeve (37.4%). Upon the first dietitian consultation, patients were proposed dietary optimization. Pre-operative weight loss was recommended but not required for surgery. In this period, 50% of the patients increased their weight and only 22.2% had a significant (> 2 kg) weight reduction. The 1 month %EWL was 26% and the 12 months %EWL was 81.5% and were not statistically different according to pre-operative weight change. Patient with pre-operative weight loss had significantly lower BMI (40.5 vs 44.5; p = 0.03) at the day of surgery, although their maximum BMI was not different. After adjustment for initial BMI and type of surgery, pre-operative weight change was not related with 1 month and 12 months weight loss (p = 0.9). Conclusion: Mandatory pre-operative weight loss is not associated with post-operative weight loss and might exclude patients who are the most in need of surgical treatment.

Aims. Laparoscopic gastric bypass (LGBP) complications rate can reach up to 17% and its perioperative and postoperative mortality rates are 0.38% and 0.72% respectively, with anastomotic leak being the most common cause. Complete dehiscence of the gastro-jejunal (GJ) anastomosis, although rare, is particularly challenging since surgical repair may not be immediately possible. Endoscopic and percutaneous treatments can be a bale out option as a bridge-to-surgery. The aim of this video is to show a combined endoscopic and percutaneous rescue management in a case of complete gastrojejunostomy disruption after LGBP. Methods: A 41-year-old female (BMI 34) underwent LGBP in July 2021 in another center. She was referred to our unit after an emergency laparotomy was performed on postoperative day (POD)-22 for active bleeding and peritonitis due to full anastomotic dehiscence and gastric remnant staple line disruption. At that time, the proximal stapling was performed at the level of the esophagogastric-junction (EGJ) and partial gastric remnant resection was also performed. An abdominal drain was left in the left hypochondrium. Gastrostomy and jejunostomy were also performed. On arrival to our center on POD-32 the CT scan showed a voluminous hydro-aerial collection occupying the left hypochondrium secondary to a dehiscence of the EGJ stapling line. An endoscopy allowed to confirm the dehiscence of the stapling at the EGJ and visualize the abdominal drain. An endoluminal-vacuum system (Endo-Sponge) through aspirated nasogastric tube was initially used to control the fistula and changed a total of three times every 48 h for one week, but not tolerated by the patient. Decision was made to attempt a percutaneous rendezvous drainage inserting a 0.035-inch hydrophilic guidewire percutaneously under fluoroscopy through the corrugated abdominal drain. The guidewire was retrieved endoscopically and exteriorized though the mouth. Under endoscopic and fluoroscopic control, a T-tube was inserted transorally, advanced over the guidewire and exteriorized through the abdominal wall leaving the T-portion in the distal oesophagus. Results: This manoeuvre allowed successful drainage of intra-abdominal collection and saliva with correction of the septic status, allowing a delayed surgical oeso-jejunal reconstruction. Conclusion : Multimodal treatment combining endoscopic and percutaneous approaches can represent an effective option in the management of complicated dehiscence, fistulas or leaks after bariatric procedures even after failure of surgical rescue.

Background: Robotic surgery is an emerging and promising technology in BC (bariatric surgery). Current studies have confirmed its feasibility and safety with a relatively short learning curve. Single-anastomosis duodenoileal shunt with vertical gastrectomy (SADI-s) is a well-known but technically challenging technique for extreme obesity in this group of patients and is therefore frequently performed as a staged laparoscopic procedure. Revision surgery for weight gain is a more technically demanding surgery that has been on the rise in recent years. The video shows a revision surgery due to weight regain and hiatal hernia of a patient with previous SG and conversion to fully robotic SADI-S (TR-SADI-S) in a patient with weight regain and hiatal hernia. Clinical Case: A 60-year-old male patient with a baseline weight of 151 kg in 2014 and a BMI of 45 kg/m2 underwent a sleeve gastrectomy (SG). He presents progressive regain until his current weight is 123 kg and BMI 37 kg/m2. In the preoperative study, a hiatal hernia was discovered. Revision surgery is proposed for Hiatoplasty, Resleeve and conversion to fully robotic SADI-s using a Da Vinci Xi® model. The patient is in the Trendelenburg position and on the left side. All trocars were robotic. A hiatal hernia was identified containing a remnant of the gastric fundus not dissected in the primary surgery. Content reduction and gastrectomy and hiatal closure are performed. Finally, a 270 cm ileal loop was measured to make a manual robotic duodenal-ileal anastomosis in four layers with absorbable sutures. There were no complications during or after surgery and the patient was discharged on the third postoperative day. Conclusion: Fully robotic surgery can be safely performed through systematic stepwise progression with minimal complications and comparable surgical times. Robotic surgery appears to offer more advantages for complex cases, such as super obesity and revision surgery. More experience is needed to understand the long-term advantages and disadvantages of the fully robotic approach.

Aims: De Garengeot hernia is a femoral hernia that contains the appendix. This rare type of hernia was first described by René-Jacques Croissant De Garengeot in 1731. This kind of hernia is rare, with an estimated incidence ranging between 0.15 and 5% of all femoral hernias. We describe the accidental finding of a De Garengeot hernia in a 65 years old woman who underwent elective TAPP procedure for a right inguino-crural swelling. Methodes: A three ports TAPP procedure was performed. Diagnostic laparoscopy showed the appendix incarcerated in the right femoral ring. A peritoneal flap was created starting from the right superior anterior iliac spine to the medial umbilical ligament. After complete reduction of the appendix, the right round ligament was transected in order to facilitate mesh placement. A 15 × 10 cm macroporus partially absorbable lightweight mesh (Ultrapro® mesh, Ethicon Inc®, Bridgewater, NJ) was placed. Absorbable tacks (Securestrap®, Ethicon Inc®, Bridgewater, NJ) were used to fix the mesh to the Cooper ligament and to close the peritoneal flaps. Results: The procedure lasted 53 min. No intraoperative nor post-operative complications occurred. The patient was discharged on post-operative day 1 and was followed up at 2 weeks, 1 and 6 months after surgery. Neither pain nor recurrence were observed. Conclusions: De Garengeot hernia is a very uncommon condition. TAPP procedure can be safely performed, in selected cases, according to surgeon’s expertise. Appendectomy can be avoided if no concomitant inflammation is found. Prosthetic mesh placement depends on the grade of local contamination.

Aims To demonstrate a safe and effective method for laparoscopic parastomal hernia repair for use in the emergency or elective setting. Methods Entry to the abdominal cavity was gained using VisiPort technique. The parastomal hernia defect was identified and small bowel adhesiolysis performed to free the bowel from the sac. Once the hernia is reduced the defect is repaired using V-lock suture and a DynaMesh secured with ProTack. Results Emergency laparoscopic parastomal hernia repair resulted in a satisfactory result and safe discharge in this patient with no further intervention required. Conclusion Laparoscopic parastomal hernia repair, as demonstrated in this video, presents a safe and effective alternative to open surgery. This gives surgeon’s and patient’s a laparoscopic alternative option to open surgery and all the benefits this confers. Key Statement This case and video demonstrate the safe use of laparoscopic surgery to perform a parastomal hernia repair in the emergency setting.

Aims The expanding number of patients with prior intraperitoneal mesh repair builds the opportunity for the general surgeon to face the need for re-laparoscopy for another pathology. In this commented video recording we are showing the issues experienced during access in the peritoneal cavity and while performing the dissection of adhesions. Methods We have reviewed all documents and video recordings of the patients with laparoscopic re-exploration after prior ventral or incisional hernia repair. Results We have identified 37 cases of laparoscopic evaluation: recurrent or primary abdominal hernia repair (n = 13), mesh related sepsis (n = 6), occlusive syndrome (n = 8), bariatric surgery (n = 6) and other pathology (n = 4). The mean percentage of the area covered by the mesh was 70%. In terms of challenges and complications, conversion to robotic surgery was needed in 2(5.4%) cases and to open surgery in 3(8.1%) due to difficult adhesiolysis. There were 6(16.2%) small bowel perforations. There were no major perioperative complications related to adhesiolysis. There are six highlights that we are considering valuable to present: 1.Difficult Dissection to IPOM mesh. 2.Grade 4 adhesions to small bowel. 3.Access cannula through omentum. 4.Access cannula through small bowel. 5.Prothesis eroding small bowel. 6.Conversion to robotic surgery. Conclusions: The video demonstrates that the minimally invasive approach after previous abdominal wall surgery is feasible but challenging. Adherences to the mesh are expected in the majority of the cases.

Aims: Presentation the safety and effectiveness of laparoscopic transperitoneal hernia repair (TAPP) approach to incarcerated inguinal hernias in the emergency setting. Methodes: In this video presentation we report a case of a 53 year old male patient, who was initially presented to our urological clinic with acute sever pain in the left groin radiating to the testicles and accompained with nausea. In the clinical examination showed a clearly swollen, irreducible and tender inguinal hernia on the left, so that we indicated an emergency surgical therapy. Results: Intraoperatively showed an incarcerated direct inguinal hernia with intestinal loop in the hernial sac without necrosis. Additional showed a big Meckel’s-diverticulum. It was performed a laparoscopic transperitoneal hernia repair with simultaneous resection of the Meckel’s divertikulum. The operation time was 24 min. The intraoperative and postoperative course was uneventfull. The Patient was descharged at the second postoperative day. Conclusions: In our experience the laparoscopic transperitoneal hernia repair is a safe, feasible and effective therapeutic option for incarcerated hernias and represents the first choice in emergency setting by selected patients. The additional advantage of a laparoscopic approach is in solving another pathologies.