Giant inguinal hernia: Report of a case and reviews of surgical techniques (original) (raw)
Related papers
Giant Inguinoscrotal Hernia: The Challenging Surgical Repair and Postoperative Management
Advances in Surgical Sciences, 2017
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.
Treatment of a half century year old giant inguinoscrotal hernia. A case report
International Journal of Surgery Case Reports, 2016
INTRODUCTION: Inguinal hernias, although a common medical entity, can on rare occasions present as giant inguinoscrotal hernias, mostly because of the patient's rejection of timely surgical management. PRESENTATION OF CASE: A 77 year old patient, with a giant inguinoscrotal hernia history for more than 50 years, was advised to undergo surgical treatment due to recurrent urinary tract infections and vague abdominal pain. Physical examination showed a right sided giant inguinoscrotal hernia extending below the midpoint of the inner thigh. Preoperative CT examination confirmed a giant inguinoscrotal hernia containing the whole of the small bowel along with its mesentery. DISCUSSION: Giant inguinoscrotal hernias are classified into three types based on size, with each one posing a challenge to treat. There are a number of surgical options and recommendations available, depending on the type of hernia. They require close postoperative observation, because the sudden increase in the intra-abdominal pressure can account for a number of complications. Our case was classified as a type II hernia, having longevity of more than 50 years. Despite this, it was treated with forced reduction and no debulking through an extended inguinal and lower midline incision, forming a 'V shaped' incision. Patient recovery was uneventful and he was discharged on the 10th postoperative day. CONCLUSION: Preoperative management and the correct surgical plan depending on the case are key elements in the successful treatment of this rare surgical entity.
Surgical management of giant inguinoscrotal hernias
Giant Inguinoscrotal Hernias continue to pose a technical challenge to the general surgeon. Awareness of all the possible contents prior to surgery is pivotal in avoiding disastrous complications. A case of a giant inguinal hernia with transverse colon as its content is presented to highlight the diversity of contents. The natural history and surgical options for treating giant inguinoscrotal hernias is discussed. Giant inguinoscrotal hernias should be operated upon at the earliest after contrast enhanced CT evaluation for ascertaining the contents. Open surgical approach to such cases is the safest.
Giant Inguinoscrotal Hernia—Report of a Rare Case With Literature Review
International Surgery, 2014
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.
Repair of the Giant Inguinal Hernia: More than mere Reduction and Reinforcement
International Journal of Surgery Sciences, 2019
Inguinal hernia repair is among the most commonly performed surgeries across the globe. Lichenstein's tension-free technique of open hernioplasty remains the gold-standard, and laparoscopic techniques have gained popularity over recent decade. Giant inguinal hernias that extend below the midpoint of the inner thigh are uncommon, challenging to manage and are more prone for post-operative complications. There is no standard treatment protocol or surgical procedure designated for the management of giant hernias which are associated with grossly disrupted local tissue architecture and compromised tissue integrity and dynamics. Large volumes of omentum and bowel make up the contents of the hernia sac, which with the natural pathological processes involved, further complicate the management. This care report and review of literature aims to elucidate a clear management protocol for Giant Inguinal Hernias.
Approach to a giant inguinoscrotal hernia.
We present an extremely huge and longstanding, giant inguinoscrotal hernia extending to below the knee with an ulcer at its base. Though hernias of this magnitude are rare, their management can be demanding and challenging. Nevertheless, in an emergency situation, the repair of the hernial defect is not essential, especially in a compromised patient. In fact, the most important step is excision of the devitalised tissue, and the final surgery can be delayed. In nonemergency management, definitive surgery can be planned either by a period of preoperative staged pneumoperitoneum, repairing after a resection of bowel and omentum, or replacing the content and ventilation of the patient to avoid the pressure on the cardiorespiratory system by forcing the tissue. This case highlights the problems encountered in management of huge hernias.
Giant Bilateral Inguinal Hernia - Original Surgical Attitude: Case Report
2016
The term giant inguinal hernia refers to an inguinal hernia that extends below the midpoint of inner thigh when the patient is in standing position. Loss of intraabdominal domain is a major problem that leads to a complex surgical approach of these hernias. We present the case of a patient who was operated for a giant bilateral inguinal hernia. The preferred method was the augmentation of the anterior abdominal wall with auto and alloplastic material, epidural anesthesia being sufficient in successfully conducting this surgery. The surgery was performed in two stages, separate for each side, the first intervention being essential.
Giant Inguinal Hernia: A Case Report
International Journal of Case Reports in Medicine, 2013
Giant inguinal hernia is rare. This may be asymptomatic or present with the complications. Contents vary from colon, small gut, vermiform appendix, mesentery, to omentum. A case of giant inguinal hernia in a 62-year-old male who presented with features of intestinal obstruction is reported. Patient had giant inguinoscrotal hernia which was tender, irreducible, and had no cough impulse. Emergency exploration via inguinoscrotal approach revealed that contents were small and large intestines, omentum, mesentery, and vermiform appendix. Right orchidectomy, reduction of contents into abdominal cavity after enlarging internal ring with a double layer closure of wall, and the reconstruction of scrotal skin were done. Giant inguinal hernia presenting as intestinal obstruction is rare.
Repair of a giant inguinoscrotal hernia
Hernia, 2009
Giant inguinoscrotal herniae are infrequent in developed countries nowadays, nonetheless they may still typically present after years of neglect. The morbidity associated with them can be signiWcant. Surgical management, although challenging even for the experienced surgeon, enables the patient to return to a reasonable level of function and quality of life. We present a case of a giant right inguinoscrotal hernia, which was treated with a multi-stage extensive operation, following adequate pre-operative respiratory preparation. The operation included reduction of the hernial contents in the abdominal cavity following omentectomy, right hemicolectomy and splenectomy, hernioplasty and reconstruction of the abdominal wall with the preperitoneal use of a Composix mesh and Wnally reductive reconstruction of the scrotum. The technique described represents a successful combination of various techniques described for the management of these patients.
RUDN Journal of Medicine, 2021
The following article devoted to the case of surgical treatment of giant inguinoscrotal hernia of a patient which signed the informed consent to the processing of personal data with dimensions of hernial sac 400x330x306 mm, size of hernial gates 9x8x7cm, loops of the small intestine, mesentery, a large number of heterogeneous liquid up to 14.7 L were determined in the hernial sac. Left herniotomy was performed. Back wall plastic of the inguinal canal was performed according to Liechtenstein. Mesh implant was used for the plastic.