Giant Inguinoscrotal Hernia - A Rare Case Managed and Review of Literature

Abstract

Massive inguinoscrotal hernias are rare hernias that extend below the midpoint of the inner thigh, in the standing position. We present a case of a 66- year-old patient with a very large irreducible bilateral direct inguinal hernia, without signs of obstruction or gangrenous changes. The patient was taken up for surgery under general anesthesia after optimizing the patient using preoperative incentive spirometry and nebulization. We used the laparoscopic transabdominal preperitoneal laparoscopic(TAPP) approach to reduce the hernial content which was followed by Lichtenstein's open bilateral inguinal hernioplasty. The patient was kept sedated and paralyzed on ventilatory support in intensive care for 2 days. Management of giant hernia is challenging due to various problems such as loss of domain, intraoperative cardiorespiratory complications, increase in intra-abdominal and intrathoracic pressures. Even after successful management recurrence is another complication faced when compared to other inguinoscrotal hernias. We describe laparoscopic reduction along with open bilateral inguinal hernioplasty as a viable technique in this patient followed by elective ventilation in the postoperative period. He did not require bowel resection as adequate abdominal relaxation is attained with this approach.