OC-092 Giant inguinoscrotal hernia treated with botulinum toxin, pneumoperitoneum and scrotoplasty associated to hernia repair

Abstract

Abstract Aim Inguinal hernias are the most frequent hernias of the abdominal wall, but giant hernias are a rare entity in developed countries. The surgical repair of these hernias is a challenge for surgeons, with high rates of postoperative morbi-mortality and recurrence. There are limited reports of cases of giant inguinal hernia treated with preoperative botulinum toxin and pneumoperitoneum and hernia repair associated with scrotoplasty. Material & Methods We present the case of a male patient of 68 years-old suffering from a giant inguinoscrotal bilateral hernia with loss of domain that was causing an extreme limitation to ambulate. The index of Sabbagh measured by images of computed tomography was 48,8%. Results We administrated preoperative botulinum toxin and progressive pneumoperitoneum (14100cc of air) before surgery. We realized a Rives-Stoppa technique with partial transverse abdominis release and scrotoplasty. Intra-abdominal pressures were measured during the early postoperative period. Seven days after surgery a restrictive respiratory failure was diagnosed needing non-invasive mechanical ventilation. Nevertheless, the evolution was satisfactory, and the patient was discharged on postoperative day 20. After a follow-up of 1 year neither hernia recurrence and no chronic pain were recorded. His quality of life improved notably. Conclusions In order to avoid the development of an abdominal compartment syndrome, the preoperative administration of pneumoperitoneum and botulinum toxin is suggested as a therapeutic option in giant hernias. Furthermore, adding scrotoplasty to hernia repair can improve functional and aesthetic results.