Surgical repair of giant inguinoscrotal hernias in an austere environment: leaving the distal sac limits early complications

Abstract

Leaving the distal hernial sac in the scrotum does not interfere with the type of hernia repair and can limit the occurrence of complications. This technique is reliable, reproducible and does not incur additional morbidity when used in selected patients.

Giant Inguinoscrotal Hernia: The Challenging Surgical Repair and Postoperative Management

“…It dramatically impairs quality of life of the patient [4]. This enormous hernia sac interferes with walking, sitting, lying down, sexual intercourse and routine work [2,4,5].…”

“…This enormous hernia sac interferes with walking, sitting, lying down, sexual intercourse and routine work [2,4,5]. Bowel irregularities and urinary problems can occur as well.…”

“…[2,4,6,7] With time, the ipsilateral spermatic cord will be greatly elongated and subsequently prone to torsion. [4,8] Testes are often atrophic, or even necrotic which may warrant orchidectomy in addition with remarkable lengthening of the cord [2,4,8]. Avoiding it would expose the patients to the risk of recurrence in the future [5].…”

“…Avoiding it would expose the patients to the risk of recurrence in the future [5]. Giant inguinoscrotal hernia will also cause extreme visceroptosis and tissue expansion of vascular pedicles with concomitant stretching of inguinoscrotal skin [2,4] Intestinal obstruction, incarceration and strangulation of the contents may also occur. [2,8] …”

“…[4,7,8] With the abdominal cavity adapted to being empty as the abdominal viscera is situated outside the cavity, reduction of the herniated viscera can cause the closure of the fascia not possible. It can lead to high intra-abdominal pressures, fascial dehiscence or abdominal compartment syndrome.…”