Repair of a giant inguinoscrotal hernia

doi:10.1054/bjps.2000.3383

British Journal of Plastic Surgery

Volume 53, Issue 6, September 2000, Pages 525-529

https://doi.org/10.1054/bjps.2000.3383 Get rights and content

Summary

We present a case of a long-standing, giant inguinoscrotal hernia extending to the patient's knees, complicated by intestinal obstruction. Initial management involved conservative treatment of the intestinal obstruction and optimising the patient's general condition. Surgical treatment included debulking the contents of the hernia sac by performing a right hemicolectomy and a small bowel resection, and reconstruction of the abdominal wall using Marlex mesh and a tensor fasciae latae flap. Although abdominal wall reconstruction for massive ventral or incisional herniae is well reported, inguinoscrotal herniae of this magnitude are much rarer and pose additional problems, which are discussed in this paper.

References (21)

HodgkinsonDJ et al.
Scrotal reconstruction for giant inguinal hernias
Surg Clin North Am
(1984)
CadyB et al.
Repair of massive abdominal wall defects: combined use of pneumoperitoneum and Marlex mesh
Surg Clin North Am
(1976)
WeitzenfeldMB et al.
Scrotal kidney and ureter: an unusual hernia
J Urol
(1980)
ReadRC
Bilaterality and the prosthetic repair of large recurrent inguinal hernias
Am J Surg
(1979)
O'HarePM et al.
Experience with the tensor fasciae latae free flap
Br J Plast Surg
(1983)
JacobsenWM et al.
Massive abdominal-wall hernia reconstruction with expanded external/internal oblique and transversalis musculofascia
Plast Reconstr Surg
(1997)
RamirezOM et al.
“Components separation” method for closure of abdominal-wall defects: an anatomic and clinical study
Plast Reconstr Surg
(1990)
CaldironiMW et al.
Progressive pneumoperitoneum in the management of giant incisional hernias: a study of 41 patients
Br J Surg
(1990)
KyleSM et al.
Massive inguinal hernia
Br J Hosp Med
(1990)
ForrestJ
Repair of massive inguinal hernia: with pneumoperitoneum and without using prosthetic mesh
Arch Surg
(1979)

There are more references available in the full text version of this article.

Cited by (52)

Transinguinal preperitoneal repair of giant inguinoscrotal hernias using Kugel mesh
2020, Journal of Visceral Surgery
Citation Excerpt :
In the surgical repair for giant inguinoscrotal hernias, it is technically challenging to restore the anatomical structure and function of the groin area. The compromised condition of the patients and the physiological changes caused by the loss of domain increase the risk of complications during the perioperative period [5,6]. A significantly increased intra-abdominal pressure (IAP) after the complete return of the herniated contents can induce abdominal compartment syndrome (ACS).
Giant inguinoscrotal hernias are rarely encountered in clinical settings, and their repair is technically challenging. The aim of this study is to evaluate the efficacy of transinguinal preperitoneal repair (TIPP) of giant inguinoscrotal hernias using Kugel mesh.
A retrospective analysis was conducted on 9 patients with 11 giant inguinoscrotal hernias who underwent TIPP repair using Kugel mesh between December 2008 and January 2019. Demographics and perioperative and postoperative data were collected, and the operative experience was summarized.
The patients underwent a successful repair procedure with simultaneous omentectomy but without resection of the other abdominal organs. The median operation time was 120 min, the median intraoperative blood loss was 75 mL and the median defect area was 72 cm². The median duration for diet restoration was 4 days, and the median postoperative hospital stay was 6 days. The drainage tube placed in the preperitoneal space was removed after a median duration of 5 days, and the drainage tube placed in the distal hernia sac was removed after a median duration of 6 days. Three patients suffered from a postoperative increase in intra-abdominal pressure, while one patient deteriorated into abdominal compartment syndrome accompanied by respiratory dysfunction. No haematomas, seromas, incisional or mesh infections, recurrence or chronic pain occurred during the follow-up period.
TIPP repair using Kugel mesh is a feasible and effective method for giant inguinoscrotal hernias.
Duodenal rupture due to giant inguinal hernia: A case report
2017, International Journal of Surgery Case Reports
Giant inguinal hernia is unusual, and duodenal rupture accompanying it is particularly very rare and significantly hard to manage surgically.
An 81-year-old man was admitted to our institution with upper abdominal pain. He had tenderness of the upper mid abdomen and a bilateral large inguinal hernia but he did not have pain in the inguinal–scrotal area. Computed tomography (CT) showed slight dilatation of the small bowel and stomach. There were no remarkable signs of incarceration of the inguinal hernia. Therefore, he was admitted to the internal ward. On the second day in hospital, he suddenly went into shock. CT revealed that there was free air and ascites in the inguinal hernia and therefore an emergency operation was performed.
The tranverse colon, ascending colon, and ileum were incarcerated, and perfolation of the cecum was found. We also detected duodenal rupture at the inferior duodenal angle. We resected the terminal ileal (almost 90 cm) and ileocecal area, followed by side-to-side anastomosis of duodenum and jejunum. We only repaired the peritoneum at the internal hernia ring. After the operation, despite intensive-care therapy, this patient passed away on the 18th postoperative day.
The mesocolon and third portion of the duodenum were strongly pulled down into giant inguinal hernia, probably causing the rupture of the inferior duodenal angle.
Giant inguinal hernia possibly provokes duodenal rupture and therefore should definitively be repaired if feasible.
Giant inguinal hernia: Report of a case and reviews of surgical techniques
2014, International Journal of Surgery Case Reports
Inguinal hernia is one of the most surgical common diseases. Giant inguinal hernia is more unusual and significantly challenging in terms of surgical management. It is defined as an inguinal hernia that extends below the midpoint of inner thigh when the patient is in standing position.
A 67-year-old male presented with giant right-side inguinal hernia with symptoms of partial colonic obstruction and significant weight loss. Barium enema revealed ascending colon, cecum and ileum contained in hernia sac without significant lesions of large bowel. He underwent hernia repair with omentectomy. Hernioplasty with polypropylene mesh was performed without any complications. He recovered uneventfully.
There were several repair techniques suggested by published articles such as resection of the content and increased intraabdominal volume procedure. Many key factors for management of the giant inquinal hernia were discussed. A new classification of the giant inquinal hernia was described.
Surgical repair for the giant inquinal hernia is challenging and correlated with significant morbidity and mortality due to increased intra-abdominal pressure.
Botulinum Toxin A as an Adjunct for the Repair Giant Inguinal Hernias: Case Reports and a Review of the Literature
2024, Journal of Clinical Medicine
A case of giant inguinoscrotal hernia managed by preoperative pneumoperitoneum with an unforeseen complication and outcome: a case report and review of literature
2023, Hernia
Challenges and hurdles in managing giant inguinoscrotal hernia: A case report
2023, Polish Annals of Medicine

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¹: Previously, Specialist Registra in Plastic Surgery, Derriford Hospital, Plymouth PL6 8DH, UK.

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Case reportRepair of a giant inguinoscrotal hernia

Summary

Surg Clin North Am

Surg Clin North Am

J Urol

Am J Surg

Br J Plast Surg

Massive abdominal-wall hernia reconstruction with expanded external/internal oblique and transversalis musculofascia

Plast Reconstr Surg

“Components separation” method for closure of abdominal-wall defects: an anatomic and clinical study

Plast Reconstr Surg

Progressive pneumoperitoneum in the management of giant incisional hernias: a study of 41 patients

Br J Surg

Massive inguinal hernia

Br J Hosp Med

Repair of massive inguinal hernia: with pneumoperitoneum and without using prosthetic mesh

Arch Surg

Case report
Repair of a giant inguinoscrotal hernia