Abstract
Objective: To describe and evaluate the clinical value of preperitoneal tensionfree repair of inguinal hernias combined with ascites via the hernia sac top (HST) pathway. Methods: We retrospectively reviewed the medical records of seven patients with inguinal hernia combined with ascites who underwent preperitoneal tension-free repair via the HST pathway from January 2010 to November 2013. An abdominal drainage tube was placed in the pelvic cavity intraoperatively and a negative pressure suction device was positioned under the aponeurosis of the external oblique muscles postoperatively. Results: The ascites of all patients were effectively controlled perioperatively. Surgery via the HST pathway was successful in all patients. The mean surgical duration was about 60 min. There were no obvious postoperative complications, such as scrotum hematoma, seroma, bulging of the repaired area, severe pain, or hernia recurrence. This method also resulted in less scar formation, which helps to maintain tissue softness. All patients were satisfied with treatment. Conclusion: Preperitoneal tension-free repair of inguinal hernia combined with ascites via the HST pathway was effective and maintained the integrity of the ventral transverse fascia. The HST pathway is a reliable choice for repair of inguinal hernia accompanied by ascites. Mini-Abstract: Our purpose is to describe and evaluate the clinical value of preperitoneal tension-free repair of inguinal hernias combined with ascites via hernia-roof/hernia sac top (HST) pathway. We retrospectively reviewed the medical records of seven patients with inguinal hernia combined with ascites who underwent the new procedure. An abdominal drainage tube was placed in the pelvic cavity intraoperatively and a negative pressure suction device was positioned under the aponeurosis of the external oblique muscles postoperatively. Surgery was successful in all patients. All patients were satisfied with treatment and none experienced recurrence.
Highlights
Inguinal hernia combined with ascites is intractable and surgical repair is discouraged because of the risk of postoperative complications, such as hernia recurrence, bulging of the repaired area, and incision effusion due to continuous high abdominal pressure
Inguinal hernia preperitoneal tension-free repair via the hernia sac top (HST) pathway was successful for all seven patients with sufficient healing of the incisions and no postoperative complications, such as scrotum hematoma, seroma, bulging of the repaired area, severe pain, or hernia recurrence
Surgical repair of inguinal hernia combined with ascites is associated with several complications, such as incision effusion, hernia recurrence, and bulging of the repaired area, which is difficult to treat due to high abdominal pressure
Summary
Inguinal hernia combined with ascites is intractable and surgical repair is discouraged because of the risk of postoperative complications, such as hernia recurrence, bulging of the repaired area, and incision effusion due to continuous high abdominal pressure. For the past 5 years, we adopted preperitoneal tension-free hernioplasty via the hernia sac top (HST) pathway with intraoperative placement of an abdominal drainage tube and a negative pressure suction. Vol 9 No 2 : 12 device under the aponeurosis of the external oblique muscles to maintain the integrity of the ventral transverse fascia, which increases its ability to resist high abdominal pressure, while actively reducing the volume of ascites both intra- and postoperatively [2]. We report our experience with preperitoneal tension-free repair via the HST pathway for repair of inguinal hernia combined with ascites
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