Surgical treatment of the giant inguinal hernia

Sturniolo, G; Tonante, A; Gagliano, E; Taranto, Filippo; Schiavo, Maria Grazia Lo; D'Alia, C

doi:10.1007/bf01576738

Cited by 19 publications

(28 citation statements)

References 5 publications

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“…1 These massive hernias are usually the result of neglect and fear of any surgical procedure and are more common in the rural population, affecting the quality of life adversely. 2 These patients generally have voiding difficulty and urinary retention, 4 and can develop pressure sores along the medial aspect of the scrotum 4,5 as well as infection and reduced mobility 4 apart from the usual complications of hernias. In addition, the penis can get buried inside the scrotum causing urine to dribble over the already vulnerable scrotal skin, which is congested due to lymphatic and venous edema, causing excoriation, ulceration, and secondary infection.…”

Section: Discussionmentioning

confidence: 99%

“…6 Also, the scrotal wall is thickened, and the spermatic cord stretches along with atrophy of the testis because of the massive nature of the contents. 2,3 The size of the hernia causes difficulty in walking, sitting, and lying down. Other complications include incarceration, leading to intestinal obstruction and strangulation of bowel contents.…”

Section: Discussionmentioning

confidence: 99%

“…2 These massive hernias pose significant problems resulting from cardiorespiratory compromise following sudden increase in intra-abdominal pressure during replacement of herniated viscera. 3 In order to circumvent these complications, techniques such as debulking, phrenectomy, and progressive pneumoperitoneum have been described.…”

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confidence: 99%

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Giant Inguinoscrotal Hernia—Report of a Rare Case With Literature Review

Karthikeyan

Sistla

Ram

et al. 2014

International Surgery

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Massive inguinoscrotal hernias extending below the midpoint of the inner thigh, in the standing position constitute giant inguinoscrotal hernias. We report a patient who presented with giant right inguinal hernia with bilateral hydrocele for 25 years. He had no cardiorespiratory illnesses. He was taken up for surgery under general anesthesia after preoperative respiratory exercises. Sliding hernia with entire greater omentum, small bowel, and appendix as contents was identified. Meshplasty after omentectomy with bilateral subtotal excision of sac, right orchidectomy, and scrotoplasty were done. Giant inguinoscrotal hernias pose significant problems while replacing bowel contents because of the increase in intraabdominal and intrathoracic pressures. Recurrence is another complication seen after successful surgical management. Various techniques such as preoperative pneumoperitoneum, debulking abdominal contents with extensive bowel resections, or omentectomy and phrenectomy have been tried. Postoperative elective ventilation is also needed in many cases. We describe simple reduction with omentectomy as a viable technique in this patient. He did not need elective ventilation due to preoperative respiratory exercises and preparation and review of the literature.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Giant Inguinoscrotal Hernia—Report of a Rare Case With Literature Review

Karthikeyan

Sistla

Ram

et al. 2014

International Surgery

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“…These hernias are rare in the developed world and are generally seen in clinical practice after years or even decades of self-neglect [2]. Complications of these hernias in addition to the complications common to all hernias i.e., incarceration, obstruction and strangulation also include visceroptosis, reduction in mobility, intertrigo leading to ulceration of the scrotal skin, voiding difficulties, stretching of the spermatic cord which can lead to testicular atrophy and necrosis [3]. The combination of these complications has been shown to lead to psychological sequelae and social isolation [4].…”

Section: Discussionmentioning

confidence: 99%

Giant inguinoscrotal hernia: An emergency presentation with life-threatening sepsis

Burke¹,

Joyce²,

Ahmed³

et al. 2014

IJCRI

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A 74-year-old male was brought by ambulance to the emergency department with a 12-hour history of an acutely painful scrotum with associated rapidly progressing discoloration of the overlying scrotal skin. This was on a background of a giant inguinoscrotal hernia present for approximately 12 years for which he had previously declined operative intervention. Other than well controlled hypertension, his past medical was unremarkable. Upon arrival in the emergency department, he was noted as being markedly hypotensive and displaying clinical signs consistent with septic shock. His scrotum was noted as being grossly enlarged with a black discoloration (Figure 1). Several fluids filled bullae were noted on the scrotal skin ( Figure 2). On physical examination his abdomen was soft and non-tender. Initial resuscitation was provided in accordance with ATLS and sepsis guidelines. Anesthetic input was sought and the patient was transferred to the intensive care unit for continued resuscitation in the form of central venous pressure monitoring and inotropic support prior to emergency operative intervention. The patient's condition was deemed too unstable for transfer to the radiology department for preoperative imaging.In theatre, initial incision of the scrotum and examination of the scrotal contents revealed necrotic loops of small and large bowel. Mesenteric thickening was noted at the neck of the hernia sac. In light of this, a midline laparotomy incision was made and the necrotic hernial contents were reduced into the abdominal cavity

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“…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.…”

Section: Potential Risks and Complications Of Neglected Giant Herniamentioning

confidence: 99%

Giant Inguinoscrotal Hernia: The Challenging Surgical Repair and Postoperative Management

Mohamad¹

2017

ASS

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Abstract:Inguinal hernia operations are compulsory surgical skill assessment for residence in surgical field and most centres practice day care services for such cases. Giant inguinal hernias usually occur in neglected long standing diseases and repair of these condition added challenges in term of content reduction as well as managing postoperative complications. This case was a unique case of a giant inguinal hernia which was left untreated for 40 years. The contents of the hernia which include greater omentum, small and large bowel were reduced successfully after extension of the deep inguinal ring. The patient was ventilated and paralyzed for 48 hours in view of anticipating intraabdominal hypertension. Post operatively the patient recovered well and discharged on Day 6 post operatively.

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Surgical treatment of the giant inguinal hernia

Cited by 19 publications

References 5 publications

Giant Inguinoscrotal Hernia—Report of a Rare Case With Literature Review

Giant Inguinoscrotal Hernia—Report of a Rare Case With Literature Review

Giant inguinoscrotal hernia: An emergency presentation with life-threatening sepsis

Giant Inguinoscrotal Hernia: The Challenging Surgical Repair and Postoperative Management

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