Laparoscopic Repair of Giant Inguinoscrotal Hernia

Introduction: The huge inguino-scrotal hernia (HISc) is rather rare. It would be the consequence of negligence and fear of the surgery. The sliding of viscera (intestine, colon, omentum, bladder, etc) decreases the abdominal capacity. This phenomenon makes difficult, even impossible the replacement of the slid elements. What obliges, sometimes, visceral resection? To overcome this inconvenience, Moreno proposed before the operation a progressive pneumoperitoneum over two weeks. Postulant the idea that the CO2’s insufflation and high abdominal pressure induced could open enough the abdomen to receive the viscera moved towards the huge hernia, we tried the laparoscopic approach in the treatment of this hernia.Materials and methods: Since 2002, 18 men, 54 to 82 years old with unilateral HISc: 4 giants (3 primary, 1 recurrence), 5 voluminous (3 primary, 2 recurrences) and 9 averages. Were operated by laparoscopic TAPP (trans abdomino preperitoneal). We excluded the patients who presented one or more of these situations: contraindication of laparoscopy, incarcerated hernia with occlusion, history of laparotomy and obesity.Procedure: general anaesthesia, dorsal position with pronounced declive, 14-15mmHg’s intra-abdominal pressure, Plicature of the fascia transversalis on case of direct hernia and shrinkage of th internal orifice in indirect’s case with non-absorbable suture. Mesh: large and split fixed in two median points. Redon’s drain.Results: Operative time: 60mn (50-120). Hospital stay: 7 days (5-12). Mortality 0, Morbidity: infection 0, seroma 15, hematoma 5, recurrence 3 (1 primary hernia after 10 months, 2 recurrent hernia after 4 & 24 months). They were operated by anterior approach.Conclusions: The laparoscopic approach, TAPP, for the huge and voluminous inguinoscrotal hernia is feasible and safe. The postoperative suites are more comfortable than the open surgery, with a rate of the low co-morbidity. To know the exact risk of recurrence, is needed a larger experience.