Repair of giant inguino-scrotal hernia with loss of domain using minimally invasive anterior component separation technique combined with Lichtenstein tension-free mesh hernioplasty
Keywords:Giant inguinoscrotal hernia, Inguinal hernia, Loss of domain, Anterior component separation
Inguinal hernia repairs are most commonly performed surgical procedures across the world. Lichtenstein's tension free technique of open hernioplasty is the gold standard technique, while laparoscopic techniques gained popularity over recent decade. Giant inguinal hernias are rare. Giant inguinal hernia extends below the midpoint of the inner thigh, in the standing position. These are long standing conditions and at presentation years of herniation or even decades. We report a patient of 65 years of age presented with type-II left sided giant inguinoscrotal hernia from last 10 years with loss of domain. Contrast enhanced computed tomography (CECT) revealed, omentum and ileal loops with mesentry as contained in hernia sac, which was repaired by minimally invasive anterior component separation technique to increase the intra-abdominal volume followed by omentectomy and Lichtenstein mesh hernioplasty without any complications. He recovered uneventfully. Surgical management of giant inguinal hernia is significantly more challenging and unusual because of ‘loss of domain’ and returning herniated viscera into the empty abdominal cavity forcefully can lead to high intra-abdominal pressure, recurrence or abdominal compartment syndrome. There are several repair techniques in literatures such as resection of contents and increased intra-abdominal volume increasing procedures but there is no standard protocol or surgical procedure for the management of giant hernias. We describe a technique which is relatively simple, less expensive and less invasive used for type II unilateral giant inguinoscrotal hernia with loss of domain in patient with co-morbidities.
Lau WY. History of treatment of groin hernia. World J Surg. 2002;26(6):748-59.
Hodgkinson DJ, Mcllrth DC. Scrotal reconstruction for giant inguinal hernia. Surg Clin North Am. 1980;64(2):307-13.
Hamad A, Marimuthu K, Mothe B, Hanafy M. Repair of massive inguinal hernia with loss of abdominal domain using laparoscopic component separation technique. J Surg Case Rep. 2013;3.
Stoppa RE. The treatment of complicated groin and incisional hernias. World J Surg. 1989;13:545-54.
Mendez-Fernandez MA, Hollan C, Frank DH, Fisher JC. The scrotal myocutaneous flap. Plast Reconstr Surg. 1986;78(5):676-8.
Serpell JW, Polglase AL, Antsee EJ. Giant inguinal hernia. Aust NZJ Surg. 1988;58(10):831-4.
Mehendal FV, Taams KO, Kingsnorth AN. Repair of a giant inguinoscrotal hernia. Br J Plast Surg. 2000;53(6):525-9.
Dinesh HN, Kumar J, Shreyas N. Giant inguinoscrotal hernia repaired by Lichtensteins technique without loss of domain- a case report. J Clin Diagn Res. 2014;8(9):7-8.
Karthikeyan VS, Sistla SC, Ram D, Ali SM, Rajkumar N. Giant inguinoscrotal hernia- report of a rare case with literature review. Int Surg. 2014;99(5):560-4.
Trakarnsagna A, Chinswangwatanakul V, Methasate A, Swangsri J, Phalanusitthepha C, Parakonthun T et al. Giant inguinal hernia: Report of a case and reviews of surgical techniques. Int J Surg Case Rep. 2014;5(11):868-72.
Forrest J. Repair of massive inguinal hernia. Arch Surg. 1979;114:1087-8.
Moreno IG. The rational treatment of hernias and voluminous chronic eventrations: preparation with progressive pneumoperitoneum. In: Nhylus LM, Condon RE, eds. Hernia, 2nd edn. Philadelphia: J.B. Lippincott Co. 1978;536-50.
Merrett ND, Waterworth MW, Green MF. Repair of giant inguinoscrotal inguinal hernia using marlex mesh and scrotal skin flaps. Aust N Z J Surg. 1994;64(5):380-3.
Moreno IG. Chronic eventrations and large hernias; preoperative treatment by progressive penumoperitoneum; original procedure. Surgery. 1947;22(6):945-53.
Cannolly DP, Perri FR. Giant hernias managed by pneumoperitoneum. JAMA. 1969;209(1):71-4.
Barst HH. Pneumoperitoneum as an aid in the surgical treatment of giant herniae. Br J Surg. 1972;59(5):360-4.
Mayagoitia JC, Suarez D, Arenas JC, Diaz de Leon V. Preoperative progressive pneumoperitoneum in patients with abdominal wall hernias. Hernia. 2006;10(3):213-7.
Piskin T, Aydin C, Barut B, Dirican A, Kayaalp C. Preoperative progressive peumoperitoneum for giant inguinal hernias. Ann Saudi Med. 2010;30(4):317-20.
Valliattu AJ, Kingsnorth AN. Single–stage repair of giant inguinoscrotal hernia using the abdominal wall component separation technique. Hernia. 2008;12(3):329-30.
Ramirez OM, Ruas E, Dellon AL. “Component separation” methods for closure of abdominal wall defects: an anatomical and clinical study. Plast Reconstr Surg. 1990;86:519-26.
Agnew SP, Small W, Wang E, Smith LJ, Hadad I, Dumanian GA. Prospective measurements of intra-abdominal volume and pulmonary function after repair of massive ventral hernias with the components separation technique. Ann Surg. 2010;251(5):981-8.
Butler CE, Campbell KT. Minimally invasive component separation with inlay bioprosthetic mesh (MICSIB) for complex abdominal wall reconstruction. Plast Reconstr Surg. 2011;128(3):698-709.
Sanford Z, Weltz AS, Singh D, Hanley R, Todd D, Belyansky I. Minimally Invasive Multidisciplinary Approach to Chronic Giant Inguinoscrotal Hernias. Surg Innov. 2019;26(4):427-31.