The role of the endoscopic extraperitoneal approach in large inguinal scrotal hernias

Abstract

The role of endoscopic extraperitoneal herniorrhaphy (EEPH) in the management of giant scrotal hernias has not been well defined, and the technical details relating to operations on such hernias have not been described. We present our experience with 17 patients undergoing repair of giant scrotal hernias. Foley catheter bladder decompression was routinely employed. The Retzius space was developed early in the procedure and hernia sac contents were reduced in all cases. The inferior epigastric vessels were likewise divided in all patients. The average operative time was 76 min and all patients were discharged home the same day. There have been no recurrences on follow-up. There was no mortality, and morbidity was limited to seroma formation in two patients. We conclude that with certain technical modifications, EEPH can be safely employed for the treatment of giant scrotal hernias.

Seroma following endoscopic extraperitoneal inguinal hernioplasty

“…Smith [22] suggested that local injection of triamcinolone acetonide into the swelling could hasten resolution of a refractory seroma. Lehr and Schuricht [14] recently described a three-puncture, minimally invasive approach for treating persistent postoperative seromas after laparoscopic [17] 1999 TEP/TAPP 352 6.7 O'Riordain et al [19] 1999 TEP 54 5.5 Litwin et al [16] 1997 TAPP 632 1.9 Ferzli and Kiel [8] 1996 TEP 17 (scrotal hernia) 11.7 Fitzgibbons et al [9] 1995 TAPP/TEP/IPOM 867 3.4 TEP, totally extraperitoneal; TAPP, transabdominal preperitoneal; IPOM, intraperitoneal onlay mesh ventral hernia repair. However, at present, no intervention has been shown to be an effective treatment for seroma.…”

Laparoscopic extraperitoneal approach to acutely incarcerated inguinal hernia

“…Incarcerated hernia has been among the last of the hernia types to be treated laparoscopically. The procedure still is controversial, and may be contraindicated in some cases [20], but successful reduction and repair have been reported for nonacutely incarcerated inguinal hernia [5,8,14]. Of the few studies available, most involve use of the transabdominal approach (TAPP) [5,12,14,27].…”

Scrotal hernias: a contraindication for an endoscopic procedure?

“…Ferzli and Kiel [3] reported a similar time spent using the total extraperitoneal technique (76 min operating time). Concerning the incidence of complications with TAPP technique, we found no significant difference between scrotal and normal hernia repair (0.6% vs 1.6% major complications; see Table 2).…”

“…On the other hand, complete mobilization of the sac is said to entail a risk of injuring cord structures, especially in endoscopic techniques [3]. Wantz [12] stated that conventional techniques carry a particular risk of testicular atrophy (rates of testicular atrophy: 0.36% primary hernia, 5% recurrent hernia) for large indirect hernias, a situation especially likely in scrotal hernias.…”