Lipoma of the cord and round ligament: an overlooked diagnosis?

Abstract

Lipoma of the cord, once considered rare and insignificant, has been cast in a new light by laparoscopic pre-peritoneal surgery, with diagnostic and therapeutic implications. This study aimed to determine the incidence, significance and association of spermatic cord lipomas to inguinal hernias. A retrospective review was performed for all hernia operations carried out between January 1999 and November 2002. The incidence of cord lipomas and their relation to inguinal hernias were evaluated. There were 123 repairs performed on 111 patients, 90 of which were laparoscopic via the pre-peritoneal approach, 29 were open and 4 converted from laparoscopic to open in the early part of the series. All but two cases were male (neither female had associated lipoma of the round ligament). Twenty-six lipomas of the cord were identified with an incidence of 21%. Sixteen were associated with hernia and only 10 were pure cord lipoma, an incidence of 8%. Thirteen repairs represented recurrent hernias, two of which had pure cord lipoma, one had an associated sac. Only two lipomas were suspected clinically prior to surgery. Lipoma of the cord is a poorly recognised entity that can be present with groin symptoms and clinical findings indistinguishable from inguinal hernia. Its incidence was poorly appreciated prior to the laparoscopic era.

Management of herniated retroperitoneal adipose tissue during endoscopic extraperitoneal inguinal hernioplasty

“…Unawareness of this condition would result in placing mesh posterior to the herniated retroperitoneal adipose tissue, leading to early recurrence of hernia after TEP [5,10,13]. Our results demonstrated that cord lipoma occurred in more than one-fifth of the patients with inguinal hernia, which was consistent with other reports (Table 3).…”

Lipoma of Spermatic Cord

“…Occasionally extra peritoneal fatty protrusions are often observed along the path of the spermatic cord into the inguinal canal occurring in more than one-fifth of the patients with inguinal hernia, but true Lipomas are not commonly found [2]. Its incidence was poorly appreciated prior to the laparoscopic era [3]. 70% of spermatic cord tumors are benign, out of which spermatic cord lipoma constitutes 30-35% of benign tumors.…”

Cord Lipoma - An Analogue of Preperitoneal Fat: A Laparoscopic Study

“…Moreover, Lilly and Arregui (2002) suggested a possible cause-and-effect relationship that the lipomatous lobular preperitoneal fat in the inguinal region may insinuate through the deep inguinal ring and may dilate it over the time as a predisposition to indirect hernia formation [1], i.e., cord lipoma may act as a pile driver operator that drags out a part of the peritoneum into the inguinal canal. Cord lipoma, if not excised during hernia surgery, may be a cause of persistent symptoms or even a pseudo-recurrence of hernia as reported by a number of clinical investigators [1,2,[13][14][15], and therefore excision of the cord lipomas are always recommended.…”

“…The cord lipomas are often encountered during inguinal hernioplasty but receive little attention of the operator other than an incidental finding in association with hernia [1,2]. They are excised without bothering much about its anatomy, pathology, its relationship with adjacent structure/organ and its relationship/role with respect to herniation.…”