Management of herniated retroperitoneal adipose tissue during endoscopic extraperitoneal inguinal hernioplasty

Abstract

Herniation of retroperitoneal adipose tissue into the inguinal canal occurred in more than one-fifth of the patients with inguinal hernia. Awareness and appropriate treatment of the cord lipoma helped to reduce the risk of recurrence. During TEP, the internal inguinal ring and inguinal canal should always be cleared of any herniated adipose tissue by either reduction or resection. This clearing posed no adverse effects on postoperative outcome.

The HAC trial (harmonic for acute cholecystitis): a randomized, double-blind, controlled trial comparing the use of harmonic scalpel to monopolar diathermy for laparoscopic cholecystectomy in cases of acute cholecystitis

“…The meta-analysis conducted by Lau [8] in 2007 included 204 patients and discovered evidence of failed non-surgical treatment in 23% of cases in the late VLC group; the study also found a statistically significant decrease in hospitalization (1.12 days) for patients in the early VLC group with no significant differences in duration of surgery, conversion rate, or morbidity rates.…”

CT of inguinal canal lipomas and fat-containing inguinal hernias

“…ICLs are not true tumours of fat but are extrusions of EPF through the internal inguinal ring into the inguinal canal 1–3 . There is an incidence of 36–75% for spermatic cord lipomas in male autopsies 15,16 and ICLs were found in 21–73% of herniorrhaphies 1–6 . Some of these ICLs were misdiagnosed preoperatively as inguinal hernias; some were thought to be symptomatic; they may be missed at laparoscopy; and there is concern that they may lead to a higher recurrence rate if not dealt with surgically as they may disrupt reparative mesh placement.…”

“…Small extraperitoneal vessels accompany the ICL fat towards the scrotum or labia. ICLs may play a role in true inguinal hernia formation and have also been incriminated as a factor in post‐repair recurrences 3–7 . More recently, ICLs have assumed greater significance with the use of transabdominal and extraperitoneal laparoscopic approaches for inguinal herniorrhaphies when the ICLs may be missed.…”

“…ICLs may play a role in true inguinal hernia formation and have also been incriminated as a factor in post-repair recurrences. [3][4][5][6][7] More recently, ICLs have assumed greater significance with the use of transabdominal and extraperitoneal laparoscopic approaches for inguinal herniorrhaphies when the ICLs may be missed. On CT, ICLs may be confused for mesenteric or omental fat in inguinal hernias.…”

CD Rats as an Animal Model in the Experimental Study of Laparoscopic Hernia Repair

“…In adult hernia surgery, this is referred to as a spermatic cord lipoma. The cord lipoma is described as retroperitoneal fat tissue mimicking an inguinal hernia, and the current recommendation is to treat it as an inguinal hernia [14,15] . In contrast, the paraductal lipoma in rats in our study was located intraperitoneally.…”