We inserted the first trocar at just inferior to the umbilicus or in the lower abdomen area by an open method with a new incision. Mostly, we performed the reduction using three or four trocars. The intra-abdominal reduction process was the same as that performed in the open method. However, it was difficult to determine the correct direction of herniation with a laparoscope. Therefore, we identified the ileocaecal valve, traced the bowel proximally to identify the herniating segment then reduced it with gentle traction. After complete reduction, we checked the status of bowel perforation and necrosis. If the bowel was not viable even after reduction, we resected the damaged small bowel segment. We closed Petersen’s space with non-absorbable sutures (supplement Video).

The possibility of damage or bleeding in the small intestine is higher during laparoscopic hernia reduction than during open reduction due to forceful pulling of laparoscopic graspers. We recommend open conversion for patients with a poor pneumoperitoneum condition or severely damaged bowel, as reduction is difficult due to severe bowel edema.

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