Abstract
ABSTRACT Background: Laparoscopic best approach of repairing inguinoscrotal hernias are still debatable. Incorrect handling of the distal sac can possibly result in damage to cord structures and negative postoperative outcomes as ischemic orquitis or inguinal neuralgia. Aim: To describe a new technique for a minimally invasive approach to inguinoscrotal hernias and to analyze the preliminary results of patients undergoing the procedure. Methods: A review of a prospectively maintained database was conducted in patients who underwent minimally invasive repair using the “primary abandon-of-the-sac” (PAS) technique for inguinoscrotal hernias. Patient´s demographics, as well as intraoperative variables and postoperative outcomes were also analyzed. Results: Twenty-six male were submitted to this modified procedure. Mean age of the case series was 53.8 years (range 34-77) and body mass index was 26.8 kg/m2 (range 20.8-34.2). There were no intraoperative complications or conversion. Average length of stay was one day. No surgical site infections, pseudo hydrocele or neuralgia were reported after the procedure and two patients presented seroma. No inguinal hernia recurrence was verified during the mean 21.4 months of follow up. Conclusion: The described technique is safe, feasible and reproducible, with good postoperative results.
Highlights
The success of TAPP or TEP approach for inguinal hernias is evident
In this article we describe a novel minimally invasive TAPP approach for treatment of inguinoscrotal hernias pursuing a reproducible and safe manner to overcome the difficulties of the distal sac management
Twenty-six patients with inguinoscrotal hernia were submitted to the reported technique
Summary
The success of TAPP (transabdominal preperitoneal) or TEP (totally extraperitoneal) approach for inguinal hernias is evident. The best approach in repairing large inguinoscrotal hernias and the optimal management of the distal sac and its risks are still debated. And Kiel[7] first described an extraperitoneal approach for repair of large inguinoscrotal hernias in 17 patients having acceptable results in 1996, with no recurrence. The more distal extension the sac is below mid inner thigh, the more unlikely a hernioplasty with forced reduction procedure is safe due to intra abdominal pressure control. In this article we describe a novel minimally invasive TAPP approach for treatment of inguinoscrotal hernias pursuing a reproducible and safe manner to overcome the difficulties of the distal sac management
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