Surgical treatment strategies for giant inguinoscrotal hernia – a case report with review of the literature

Abstract

BackgroundAn inguinoscrotal hernia is defined as “giant” if descending below the midpoint of the inner thigh of a patient in upright position. In developed countries this is a rare entity. In the literature different surgical techniques have been reported so far to achieve a successful treatment.Case presentationWe present the case of a 63 year-old man suffering from a giant inguinoscrotal hernia, whom we treated using a combined open transabdominal and inguinal approach following an unsuccessful laparoscopic attempt. Meshes were placed in a premuscular position (Lichtenstein’s procedure) and in a preperitoneal position. In addition, a reconstruction of the abdominal wall by modified components separation technique was performed. During the early postoperative period no complications were registered. Intensive care treatment was not necessary. The patient was discharged on postoperative day 8 in an excellent condition. Six months after surgery a scrotal hematocele was diagnosed and operatively removed. After a follow-up of 1.5 years neither hernia recurrence, nor chronic groin pain were recorded. The patient reported to be sexually active. His quality of life improved notably.Additionally, a Medline and PubMed database research was performed to create an overall picture of the existing surgical treatment strategies. Included were patients with diagnosis of primary giant inguinoscrotal hernia according to the given definition. Emergency interventions and cases without details of the surgical approach were excluded.ConclusionsFirstly, this report describes a novel, successful surgical treatment of a giant inguinoscrotal hernia without administering preoperative progressive pneumoperitoneum therapy or visceral resection. Secondly, we summarize cases previously reported as a practical guide for possible surgical therapy approaches.

New scoring system for the individualized treatment of the patient with uncomplicated inguinal hernia

“…Las nuevas guías internacionales recomiendan la individualización (por vía anterior o TAPP) según la experiencia del cirujano 15 , aunque recientes publicaciones exponen resultados favorables del tratamiento de este tipo de hernia utilizando las técnicas endoscópicas. Por ello, consideramos que el determinante para escoger entre técnicas laparoscópicas o endoscópicas y abiertas es la experiencia del cirujano en las primeras, aunque los niveles de evidencia y los grados de recomendación sobre su uso son todavía bajos en este particular 42,44,45 . Pensamos, pues, que en la mayoría de nuestros hospitales la mejor opción que se le puede aconsejar a un paciente con hernia inguinoescrotal, aunque no sea complicada, es una técnica por vía anterior, preferentemente la de Lichtenstein.…”

Successful outcome of a giant inguinoscrotal hernia: a novel two-staged repair using preoperative progressive pneumoperitoneum and transversus abdominis release

“…Giant inguinoscrotal hernias (GIHs) classically extend below the midpoint of the inner thigh, while upright [ 1 ]. Progression of hernias to this size is a considerably long process, generally requiring several years to develop before presenting [ 2 ]. Psychosocial factors such as fear, finances, low self-esteem and poor socialization habits may propagate the continuous delay of medical care, consequently further complicating the reconstruction [ 3 ].…”

“…Perioperative complications associated with an increased abdominal pressure may incite fatal cardiorespiratory failure by way of cephalad diaphragm displacement and compression of the inferior vena cava [ 4 ]. Several surgical modalities are described in the literature with varying combinations in treating GIHs [ 2 ]. However, lack of a standardized approach can make treatment outcomes variable.…”

Giant Inguino-Scrotal Hernia With Duodenal Perforation and Biliary Peritonitis - A Rare Case Report With Literature Review

“…Component separation of abdominal wall or using mesh grafts or aps to lengthening the abdominal wall also helps to achieve tension-less 14 abdominal closure .…”

“…Minimal invasive surgery like trans-abdominal pre-peritoneal (TAPP) 14 repair has also been suggested .…”