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<b>Introduction:</b> While elective surgeries have been postponed worldwide due to the COVID-19 pandemic, emergency operations cannot be delayed and are continuously being performed just like before the pandemic outbreak [1]. </br></br> <b>Aim:</b> Although elective surgeries have been postponed worldwide due to the COVID-19 pandemic, emergency operations cannot be delayed and are continuously being performed. In general surgery practice, incarcerated / strangulated inguinal hernias take a prominent place among emergency surgeries. In 1% of these patients, the hernia contents retreat spontaneously into the abdomen until the hernia sac is opened. It is strongly recommended that these bowel segments be evaluated for possible intestinal necrosis.</br></br> <b>Results:</b> Patients who underwent emergency surgery and hernioscopy in the Sakarya Training and Research Hospital General Surgery Service due to incarcerated or strangulated inguinal hernia between March 2020 and October 2020 were included in the study. Hernioscopy procedure was performed using the single-port and glove-port methods. For each patient, the following variables were recorded: age, duration of complaints, comorbidities, hernia repair method, operation time, incarcerated organ, postoperative complications and whether ischemia improved after reduction or resection was required. </br></br> <b> Conclusion:</b> Hernioscopy is a procedure performed under spinal anesthesia which prevents unnecessary laparotomies and should be considered as first-line treatment during the COVID-19 pandemic in patients who undergo emergency surgery for strangulated inguinal hernia.

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INTRODUCTION: The publication of new guidelines in recent years shows that surgical treatment of inguinal hernia remains topical. The main goal is to improve patient outcomes, specifically to decrease recurrence rates and reduce chronic pain. The main purpose of this article is to summarize the latest recommendations in surgical treatment of the groin hernias, especially in the case of strangulation. METHODS: The authors made literature review of all the guidelines published by the hernia societies, including related articles, in the last ten years. RESULTS: The use of the EHS classification system is suggested. In elective operations, mesh repair is recommended. The Lichtenstein technique is the standard in open inguinal hernia repair. Transabdominal preperitoneal and totally extraperitoneal approach have comparable outcomes. Their clear advantages include minimal invasiveness. Mesh repair is recommended also in the case of strangulation, but only in clean and clean-contami-nated operations. A laparoscopic approach should be considered as well. Inter alia, it allows an assessment of bowel viability during the whole procedure. The need of bowel resection is hence lower compared to open surgery. If it is not possible to use the mesh, the Shouldice method is regarded as the best non-mesh repair technique. If there is concern about bowel viability, visualization, either by formal laparoscopy, hernia sac laparoscopy or laparotomy, is recommended. Hernioscopy is a simple and safe procedure that uses the hernia sac for insertion of a port following insufflation and diagnostic examination. It requires less advanced laparoscopic skills than does emergency laparoscopic hernia repair. It can be performed even by surgeons who lack sufficient experience with laparoscopy. CONCLUSION: In elective procedures, the mesh repair is recommended. It is recommended also in the case of strangulation, but not in a contaminated-dirty surgical field. If there is concern about bowel viability, visualization, either by formal laparoscopy, hernia sac laparoscopy or laparotomy, is needed.

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Visual inspection of the content of the hernia sac is a crucial step of the emergency repair of strangulated inguinal hernias, to rule out the presence of bowel ischaemia which would need resection. Occasionally the content of the hernia sac reduces spontaneously into the abdomen after the induction of general anaesthesia and cannot be assessed. We present a case where hernioscopy t(i.e. laparoscopy through the hernia sac) has been used to confirm the ischaemia of the strangulated bowel and perform a hybrid laparohernioscopic right colectomy with intracorporeal anastomosis without the need for a formal laparotomy. Hernioscopy is an easy and reliable method to assess the viability of the content of the hernia sac in strangulated hernias that have spontaneously reduced before it could be visually inspected. It can also be associated with a laparoscopic access in a hybrid laparohernioscopic technique to perform complex procedures.

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PURPOSE: The diagnosis of bowel or omental ischaemia in strangulated inguinal hernias needs visual exploration of the content of the hernia sac. In some cases, the content of the sac retracts spontaneously into the abdomen at the induction of anaesthesia, so making sure of its viability can be quite difficult. Hernioscopy can allow direct inspection of the whole abdominal cavity and the performance of surgical procedures such as small bowel, large bowel or omental resection, without the need of a formal laparotomy. METHODS: Hernioscopy entails inserting a 10-12-mm trocars in the hernia sac, after its complete mobilization. A 30° camera is then passed into the abdomen through the sac and a thorough examination of the abdominal cavity is performed. If necessary, accessory trocars can be inserted into the hernia sac or through the abdominal wall to perform additional procedures such as bowel resection. After the exploration and the eventual resection, the operation is concluded with a tension-free mesh repair of the hernia. RESULTS: We performed hernioscopy on eight patients. In four of them, no ischaemia was found and the operation was concluded with mesh repair of the hernia. In four patients, a further operative procedure was necessary. No significant postoperative surgical complications were recorded. CONCLUSIONS: Hernioscopy is an easy and reliable method to explore the abdominal cavity and make sure of the viability of the bowel in patients with strangulated inguinal hernia and to proceed to minimally invasive resection if needed.

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Hernioscopy is essentially hernia sac laparoscopy. Hernia repair has evolved over the years with better outcomes; however, strangulated inguinal hernias are acute surgical emergencies which require emergent operative intervention. During anesthesia induction and/or after incision, hernia self-reduction is possible, with or without compromised bowel, back into the abdominal cavity. It is pivotal to examine the bowel to decide on further operative course. A simple alternative to unnecessary laparotomy or standard laparoscopy is hernioscopy, which is quite uncommon. We present a case of an acute symptomatic strangulated left-sided inguinal hernia which got self-reduced during anesthesia induction and was successfully repaired after hernioscopy was used to evaluate the incarcerated hernia content. We provide a brief review of literature about hernioscopy and an algorithm to guide surgeons in emergent cases.