V-016 TAPP APPROACH FOR A GIANT INGUINOSCROTAL HERNIA

Abstract

Abstract Aim We present the case of a patient with giant inguinoscrotal hernia and the laparoscopic approach performed. Material & Methods 54yo Male, no medical history except for BMI41. He is evaluated in outpatient clinic for asymptomatic left inguinoscrotal hernia of ten years of evolution. He denies digestive symptoms. Difficulty in urination without symptoms of obstruction. On examination, 20×15cm left not reducible inguinoscrotal hernia extending to the mid-thigh. Minimally invasive approach, TransAbdominal PrePeritoneal, was performed. The content of the hernia is a long portion of sigma and a large amount of fat from the greater omentum. After returning them to the abdominal cavity with the help of pressure from the outside, the TAPP technique was performed without incident, with localization of elements of the spermatic cord. Polypropylene mesh 12×15cm fixed with tackers and cyanoacrylate is placed. Results the patient was discharged on the 4thPO day with no incidents. Subsequently he developed a large seroma that required percutaneous drainage and heart failure that caused large scrotal edema, resolved with diuretic treatment. Ten months later there is no recurrence. Conclusions Giant inguinoscrotal hernia is a surgical challenge. Anterior or posterior approach, open or minimally invasive, can be performed. Sometimes intestinal resection and/or orchiectomy is required. The need for preoperative conditioning with botulinum toxin and even pneumoperitoneum can be considered. We presume that, when possible, the minimally invasive posterior approach is the best technique for these large defects since it provides the best surgical field in the most resistant plane for inguinal hernia repair.