Giant sliding inguinal hernia requiring intraoperative aspiration of fluid: a case report and literature review

Abstract

Giant inguinal hernias are defined as inguinal hernias that extend below the midpoint of the inner thigh when the patient is in the standing position or an anteroposterior diameter of at least 30 cm or a laterolateral diameter of ~50 cm with non-reducibility for >10 years. This article presents a 39-year-old male with a five-year history of a giant left inguinal hernia that was treated with left inguinal hernia repair with mesh, orchiectomy, complicated scrotoplasty, intraoperative ultrasound and aspiration of 3.9 L of fluid from the hernia sac. Surgical repair of giant inguinal hernias can be challenging and is associated with a variety of complications. Various modalities have been described to assist in hernia reduction including debulking, or, as in this case, aspiration of the hernia sac and a preperitoneal incision. Although the Lichtenstein tension free repair is commonly used, no standard approach has been accepted.

Sliding inguinal hernia: a technical challenge

“…Sliding inguinal hernia continues to pose both a diagnostic and surgical dilemma. [2][3][4] Sliding inguinal hernia is associated with a higher recurrence rate as compared to other inguinal hernias. Complete awareness of the abnormal anatomy of this hernia is essential to prevent damage to the viscera during repair.…”

“…This provides a road map for determining the best surgical option for repair. [4][5][6] Majority of cases reported in literature have described that the diagnosis of a sliding inguinal hernia is made on table. [7][8][9] Due to the intricate anatomy of the sac, dissection needs to be done carefully avoiding injury to the colon.…”

“…Bevan's technique is a safe option to deal with the sac. 3,4,8 An inverted U-shaped incision is made on the 1 cm lateral and parallel to the extraperitoneal portion of the sigmoid colon. This enables the colon to be reposited back into the peritoneal cavity.…”

Combinación de técnicas quirúrgicas en la hernia gigante de Amyand irreductible

“…Palabras claves: apéndice cecal, apendicitis, herniorrafia, hernia inguinal L as hernias de la pared abdominal representan un problema de salud a nivel mundial, con una prevalencia de 1,7% para todas las edades 1 . La Hernia Inguinal (HI) en relación con todas ellas constituye del 60 al 75% [1][2][3] , y el riesgo de ocurrencia en el hombre es de 27 al 43%, mientras en mujeres es solo del 3 al 6% [3][4][5] . Los grupos de edades más afectados se encuentran entre los 30 a los 59 años 3 .…”

Giant inguinal hernia repair using standard transverse inguinal incision with mesh. A retrospective case control study

“…Inguinal hernia is a common situation and one of the most common surgical procedures [ 1 , 2 ]. A giant inguinoscrotal hernia is defined as an inguinal hernia extending below the midpoint of the inner thigh when the patient is standing [ 3 ].…”