813 Giant Inginoscrotal Hernias: Considerations for Optimisation of Patient Outcomes

Abstract

Abstract Giant inguinoscrotal hernias (GISH) are unique and complex surgical challenges due to their rare presentation in the western world and the high risk of post-repair complications such as abdominal compartment syndrome and multi-organ failure. They are defined as inguinoscrotal hernias that extend below mid inner thigh. Due to the potential complications, optimising these patients throughout their hospital admission is crucial. Here, we present a 30-year-old Caucasian male who was admitted to our surgical unit in a public health system with a painful giant inguinoscrotal hernia, the complications he encountered and the lessons we learned. His CT scan demonstrated a strangulated hernia, for which he underwent an emergency open mesh repair. Post-operatively, he experienced severe respiratory compromise due to lower lobe collapse, which was attributed to the concomitant pneumonia present on admission, sub-optimal utilisation of analgesia and loss of domain. The complications were compounded by anxiety about medical intervention which delayed investigations and treatments. We highlight the importance of early identification of GISH, ensuring cardio-respiratory function is optimised pre- and post-operatively, and a multi-disciplinary approach to improve compliance with treatment including extensive counselling to increase engagement with healthcare services.