Abstract
ObjectiveInguinal hernia surgery is the most common surgery performed by pediatric surgeons. Giant inguinoscrotal hernia has not been clearly defined yet. The definition of giant inguinoscrotal hernia and the reliability of the surgical procedure were investigated in this study.Materials and methodsSixtyfour of totally 1548 male patients who have been operated with inguinal hernia from May 2015 to January 2018 were included in the study considering the diagnosis of giant inguinoscrotal hernia. The criteria for the diagnosis of giant inguinoscrotal hernia were determined as, observing that the hernia sac was filled with intestinal loops from the inguinal region to the scrotum during the physical examination, herniation of the intestines to the scrotum again as soon as the hernia was reduced and 2 cm and above inner ring diameter. High ligation and hernioplasty to 29 (45.3%) patients and hernioplasty using Zig maneuver to 35 (54.6%) patients were performed during the study.ResultsPostoperative wound infection was observed in 2 patients (6.8%) with high ligation and 1 (2.8%) patient with hernioplasty with Zig maneuver. Scrotal edema was detected in all the patients, which persisted until postoperative month 1. Recurrence was seen in 6 (20.6%) of 29 patients who operated using the high ligation method while it was seen in 2 (5.7%) of other 35 patients. None of the patients had testicular atrophy and/or iatrogenic undescended testis.ConclusionGiant inguinoscrotal hernias should be defined and evaluated as a group apart from classical inguinoscrotal hernias. Recurrence and morbidity rates were lower in patients who underwent hernioplasty using Zig maneuver.
Highlights
Even though herniation of the intestines from the inguinal canal to the scrotum is considered inguinoscrotal hernia, the giant inguinoscrotal hernia has not been clearly defined yet in the literature
The criteria for the diagnosis of giant inguinoscrotal hernia were determined as, observing that the hernia sac was filled with intestinal loops from the inguinal region to the scrotum during the physical examination, herniation of the intestines to the scrotum again as soon as the hernia was reduced and 2 cm and above inner ring diameter (Fig. 1a–c)
Postoperative wound infection was observed in 2 patients with high ligation and 1 patient with hernioplasty with Zig maneuver
Summary
Even though herniation of the intestines from the inguinal canal to the scrotum is considered inguinoscrotal hernia, the giant inguinoscrotal hernia has not been clearly defined yet in the literature. The incidence of inguinal hernia in term male infants is 3% and this rate can be as high as 30% in preterms. The preferred surgical technique is high ligation. Recurrence rate in high ligation has been reported below 2%. Recurrence rate in giant inguinoscrotal hernia is around 10%. Dissection of the sac from the cord and vasculatures is very difficult and the probability of rupture of the sac is high and requires a surgical experience. The aim of the present study was to investigate the definition of giant inguinoscrotal hernia and the recurrence rate in patients with and without Zig maneuver
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