When incarcerated inguinal hernia content returned to the abdominal cavity spontaneously after general anesthesia, the traditional options chosen by the surgeon tend to be treatments based on observation or an exploratory laparotomy. Hernia sac laparoscopy (hernioscopy) performed following insertion of a laparoscope through the hernia sac, is simple and accurate technique with the potential to prevent unnecessary laparotomies after spontaneous incarcerated inguinal hernia reduction [5, 6]; however, this is the foundation for open surgery.
The transabdominal preperitoneal approach, is a safe and effective surgical method for inguinal hernia , and can provide the best operative field of vision, sufficient time to observe the vital recovery of hernia contents (especially lustre and peristalsis of intestinal canal), and reduce unnecessary intestinal resection. In fact, the color change, the peristalsis and the vitality of the intestine, if in doubt, the intestinal vitality involved in incarceration, is definitely an advantage for open procedure, because the surgeon in the open procedure has less time to make a decision about whether to perform a bowel resection . It is therefore recommended that repair of incarcerated hernias may be performed with a laparoscopic approach in the guidelines of the World Society of Emergency Surgery (WSES) [8, 9]. In our experience, we believe that use of laparoscopic examination is a reasonable method for two reasons: 1) we could accurately assess the condition of the small intestine, and sutured the perforation; 2) this approach established the foundation for TAPP. The risk of reoperation was avoided because the perforation was detected in a timely manner.
Mesh repair is recommended as the first choice, either by an open procedure or a laparo-endoscopic repair technique . A well-done cohort study of Lichtenstein repairs in a clean-contaminated area (enterectomy vs. nonenterectomy) revealed that it was safe to repair acute incarcerated inguinal hernia using a non-absorbable mesh (monofilament polypropylene) with an acceptable rate of wound infection and recurrence . However, there is no medical recommendation yet regarding the optimum choice of mesh for patients with of bowel perforation (contaminated-dirty area).
A biologic mesh is mainly composed of collagen, elastin, glycoprotein and mucin, which are an extracellular matrix fiber mesh scaffold. BioMesh Study Group did not recommend the routine use of biologic mesh under contaminated conditions, because the cumulative data regarding biologic mesh use in ventral hernia do not support the claim that it is better than synthetic mesh used under the same conditions . Previous literature has expressed the effectiveness of the use of biologic mesh under contaminated conditions; unfortunately it included in reviews consisted low level of evidence .
In the guidelines of the WSES, biologic meshes may be a valid option for emergency hernia repair in contaminated-dirty surgical fields but merit a detailed cost-benefit analysis . However biologic mesh can repair abdominal wall defects by stimulating endogenous tissue regeneration, and possesses more powerful anti-infection ability which is one of the main marketed described advantages of biologic meshes [13–15]. As early as 2002, Franklin et al.  reported for the first time the research of hernia repair with biologic meshes from porcine small intestinal submucosa in 25 cases of external abdominal hernia under contaminated or seriously contaminated environment; the average follow-up period was 15 months, and no complication related to the mesh and hernia recurrence was found. Later, patients were expanded to 53 cases, and the same results were still obtained after an average observation period of 19 months . FitzGerald JF et al.  reported that the recurrence rate was significantly reduced when biological mesh used to reinforce the repair compared with used as a bridge. From the perspective of economics, Schneeberger et al.  reported that with the decrease of biologic mesh cost and the increase of long-term complications of synthetic mesh, biologic mesh was more economical and effective than synthetic mesh.
For these reasons, we sutured the hernia rings and chose biologic meshes to repair hernias in this research, and the results showed that the patient benefited from the treatment. Drainage tubes were placed between the peritoneum and meshes to prevent inflammatory infiltration and seroma formation. However, despite this minor complication (1 case of temporary seroma, 2 cases of early postoperative pain), the patient recovered steadily.