Inguinoscrotal Hernia Research Articles

OV04 MASSIVE INGUINAL-SCROTAL HERNIA WITH RETROPERITONEAL CONTENTS AND URETER: VIDEO CASE REPORT OF ROBOTIC REPAIR USING INTRAOPERATIVE FLUORESCENCE IMAGING

Abstract Aim Inguinal hernias containing the ureter and retroperitoneal contents are uncommon. We present a robotic repair of a large inguinal-scrotal hernia containing the ureter as a video case presentation. Material and Methods A 66 year old male with no previous abdominal surgical history presents with a large left sided inguinal-scrotal hernia, as well as smaller ventral and right inguinal hernias. On CT imaging the patient was found to have an ectopic pelvic location of the left kidney with evidence of the left ureter coursing into the hernia with a significant amount of retroperitoneal fat. The patient was taken to the operating room for a robotic bilateral inguinal hernia repair and ventral hernia repair. Results A ureteral catheter was placed preoperatively and instilled with indocyanine green (ICG). The hernias were successfully repaired, and intraoperative fluorescence imaging was successfully used to visualize the ureter as it was reduced with the hernia sac. The robotic platform significantly aided in dissection of the large volume of retroperitoneal fat, while being able to quickly transition to intraoperative fluorescence to clearly visualize the course of the ureter. The patient did well post operatively with no complications. Conclusions We present a video case report of a large ureter-containing inguinoscrotal hernia that was successfully repaired using a robotic preperitoneal approach. Use of the robotic platform and indocyanine green/intraoperative fluorescence imaging were helpful adjuncts in aiding dissection by improving intraoperative visualization of the ureter.

EP.TH.375Inguinal hernia repair: A systematic analysis of online patient information using the modified Ensuring Quality Information for Patients tool

Abstract Aims Online resources are a fundamental source of healthcare information due to the increasing popularity of the Internet, therefore ensuring accuracy and reliability of websites is crucial to improving patient education and enhancing patient outcomes. Inguinal hernia repair is the most commonly performed general surgical procedure worldwide. This study aims to analyse the quality of online patient information on inguinal hernia repair using the modified Ensuring Quality Information for Patents (EQIP) tool. Method A systematic review of online information on inguinal hernia repair was conducted using 4 search terms: “inguinal hernia”, “groin hernia”, “inguinal hernia repair” and “inguinoscrotal hernia”. The top 100 websites for each term identified using Google were assessed using the modified EQIP tool (score 0-36). Websites for the paediatric population or intended for medical professional use were excluded from analysis. Results 142 websites were eligible for analysis. 52.8% of websites originated from the UK. The median EQIP score for all websites was 17/36 (IQR 14-21). The median EQIP scores for Content, Identification and Structure were 8/18, 2/8, and 8/12, respectively. Complications of inguinal hernia repair were included in 46.5% of websites, with 9.2% providing complication rates and 14.1% providing information on how complications are handled. Conclusions This study highlights that the current quality of online patient information on inguinal hernia repair is poor, with minimal information available on complications, hindering patients’ ability to make informed decisions regarding their healthcare. To improve patient education, there is an immediate need for improved quality online resources to meet international standards.

EP.FRI.103 Acute Appendicitis in an Amyand Hernia – a case report and literature review

Abstract Introduction An Amyand Hernia (AH) is the presence of an Appendix within an Inguinal Hernia. We present here our clinical management of acute appendicitis in an AH and subsequent literature review. A 73 year old male patient presented with a two day history of right sided irreducible inguinoscrotal hernia with tender swelling on standing and walking. This was not associated with symptoms of bowel obstruction or fevers. Blood investigations revealed a raised C-Reactive Protein of 129m/l and White Cell Count of 15x 10^9/L. A Computed Tomography scan of the Abdomen and Pelvis revealed a right sided inguinoscrotal hernia arising lateral to the inferior epigastric vessels, containing an inflamed appendix and omental fat. The patient underwent an emergency open hernia repair with mesh and, considering that the appendix base was intra-abdominal, also underwent a laparoscopic appendicectomy. Method We conducted a literature review on Pubmed and Medline using the MeSH terms ‘Amyand Hernia’ AND ‘Appendicitis’ from 1970-2020. Results We longlisted 179 articles. Of these, 117 were excluded, as they were either paediatric cases, not relevant or mentioned in discussions. Finally, 62 relevant articles were included in the review. Conclusion Acute Appendicitis in Amyand Hernias has an incidence of 0.07-0.13%. Most cases remain as incidental findings however, increased use of imaging techniques has allowed accurate diagnoses and attempts at classifications. There is also weak association with Situs Inversus and atypical appendiceal tumours including adenocarcinoma, carcinoid and neuroendocrine tumour. Their management varies according to the extent of inflammation, radiological and intraoperative findings.

827 Acute Appendicitis in An Amyand Hernia – A Case Report and Literature Review

Abstract Introduction An Amyand Hernia (AH) is the presence of an Appendix within an Inguinal Hernia. We present here our clinical management of acute appendicitis in an AH and subsequent literature review. A 73-year-old male patient presented with a two-day history of right sided irreducible inguinoscrotal hernia with tender swelling on standing and walking. This was not associated with symptoms of bowel obstruction or fevers. Blood investigations revealed a raised C-Reactive Protein of 129m/l and White Cell Count of 15x10^9/L. A Computed Tomography scan of the Abdomen and Pelvis revealed a right sided inguinoscrotal hernia arising lateral to the inferior epigastric vessels, containing an inflamed appendix and omental fat. The patient underwent an emergency open hernia repair with mesh and, considering that the appendix base was intra-abdominal, also underwent a laparoscopic appendicectomy. Method We conducted a literature review on Pubmed and Medline using the MeSH terms ‘Amyand Hernia’ AND ‘Appendicitis’ from 1970 to 2020. Results We longlisted 179 articles. Of these, 117 were excluded, as they were either paediatric cases, not relevant or mentioned in discussions. Finally, 62 relevant articles were included in the review. Conclusions Acute Appendicitis in Amyand Hernias has an incidence of 0.07-0.13%. Most cases remain as incidental findings however, increased use of imaging techniques has allowed accurate diagnoses and attempts at classifications. There is also weak association with Situs Inversus and atypical appendiceal tumours including adenocarcinoma, carcinoid and neuroendocrine tumour. Their management varies according to the extent of inflammation, radiological and intra-operative findings.

Feasibility of modified-TEP technique for large inguinoscrotal and large femoral hernia and its advantages.

To describe the feasibility of modified-TEP technique in reducing dead space in large inguinoscrotal and large femoral hernia to prevent seroma, reduce recurrence and complications. This is a case series of patients who have completed a minimum of 9months follow-up after undergoing elective endo-laparoscopic inguinal hernia repair with modified-TEP technique for large inguinoscrotal and large femoral hernia in a single institution from June to October 2020. 14 large inguinoscrotal hernia and 4 large femoral hernia were repaired using the modified-TEP technique in 15 patients. These patients reported minimal pain after surgery. There were no reported seroma, complications or recurrences up to 9months follow-up period. Modified-TEP technique for large inguinoscrotal and large femoral hernia has shown good outcomes and patients reported minimum levels of pain. In experienced hands, it is safe, feasible and effective in reducing seroma formation and hernia recurrence.

Bilateral giant inguinoscrotal hernia: A case report.

IntroductionBilateral giant inguinoscrotal hernia (GIH) is rare and creates significant challenge in surgical management. The main concern of hernia reduction to abdominal cavity is development of abdominal compartment syndrome (ACS). Different approaches for prevention of ACS after surgery have been suggested.Case presentationWe report a case of 68-year-old male with bilateral inguinoscrotal hernia for 20 years reaching just below midpoint of thigh. He presented with difficulty in micturition and mobility. Preoperative investigations were normal. He underwent bilateral mesh repair without any preoperative or intraoperative adjunct measures. No significant complication occurred in postoperative period.Case discussionBilateral GIH is rare and the patients usually present late. GIH has been classified into three types on the basis of extension. Type I GIH can be managed with simple hernioplasty, in both unilateral and bilateral cases. Measures like resection of hernia contents and measures to enlarge intraabdominal space are warranted in type II and III GIH. Abdominal volume can be increased by utilising techniques like Pre-operative Progressive Pneumoperitoneum (PPP), injection of Botulinum toxin A (BTA) in the anterior abdominal wall, and rotation of viable tissue. The measures can be used either alone or in combination.ConclusionType I GIH can be treated with simple hernioplasty with safety with monitoring for features of ACS and respiratory complications postoperatively. However, additional measures like resection of hernia contents or procedures to enlarge intra-abdominal space are warranted for type II and III GIH.

Open Stoppa technique for the management of a bilateral inguinoscrotal hernia (with video).

To conduct a survey of current practice in the management of obstetrical anal sphincter injuries (OASI) and to compare short, medium and long-term practices according to the specialty of the surgeon.A 50-item questionnaire was addressed by mail to various specialists via the national learned societies. The questionnaire was addressed only to practitioners who currently managed OASI in their practice.Of the 135 healthcare professionals who responded, 57 were sub-specialists in ano-rectal surgery (42.2%) and 78 were obstetrical or gynecological specialists (OB-GYN) (57.8%). Management in the acute period after OASI was similar among the specialties and 50% of the practitioners did not perform suture repair of the internal sphincter. Furthermore, few gynecological specialists recommended systematic consultation with an ano-rectal specialist during acute management. In the medium term, ano-rectal specialists were more likely to explore gastro-intestinal symptoms, either clinically or through para-clinical studies. However, these studies did not systematically lead to interventional management in the absence of consensus, particularly for medium-term sphincter repair. In addition, 25% of practitioners recommended that patients undergo systematic delivery by caesarean section for further pregnancies after OASI. In the long term (> 12 months), there were substantial differences in management of OASI not only between specialties but also within the same specialty.The various specialists should coordinate to propose multidisciplinary recommendations on the management of OASI.

Диагностика и лечение пахово-мошоночных грыж у детей

Введение. Паховая грыжа — наиболее частое заболевание в практике детского хирурга и составляет 70–85 % от всех грыж у детей. Целью нашей работы является улучшение результатов диагностики и лечения пахово-мошоночных грыж у детей. Материалы и методы. Проанализировано 186 детей с пахово-мошоночными грыжами в период с 2010 по 2015 г. Односторонняя паховая грыжа — 68,4 % случаев, двусторонняя — 31,6 % случаев. У 76 детей паховая грыжа сочеталась с пупочной грыжей, с водянкой оболочек яичек — у 20 детей. Результаты и обсуждение. Анализируя полученные результаты, мы обнаружили, что у 84,9 % детей диагностика грыж основывалась на жалобах родителей и физикальном осмотре детей. Оперативное лечение 78 (42 %) детям произведено открытым доступом. 108 (58 %) пациентам произведена лапароскопическая коррекция. Из них у 28 детей грыжа с другой стороны была диагностирована во время оперативного вмешательства. В течение года после операции у 18 детей выявлена метахромная грыжа (контралатеральной области). У 12 детей с пахово-мошоночными грыжами огромных размеров выявлена водянка оболочек яичек. Выводы. 1. Оптимальным сроком операции является время установления диагноза с целью предупреждения осложнений и повреждений органов мошонки. 2. Лапароскопический доступ позволяет без труда произвести операцию с двух сторон, что, в свою очередь, предупреждает возникновение контралатеральных грыж в катамнезе.

Single stage repair of a giant inguinoscrotal hernia by a combined laparotomy and inguinal approach.

Giant inguinoscrotal hernias are an uncommon but challenging surgical entity. We report on how to repair a giant inguinoscrotal hernia using a single-stage approach suitable for emergency surgery. This involves a combined laparotomy and inguinal approach, with posterior component separation and transversus abdominis release.

Giant primary scrotal lipoma in a low-resource setting: challenges with diagnosis and review of literature.

Lipoma is the commonest benign mesenchymal tumor composed of matured adipocytes. A literature search revealed few reported cases of giant scrotal lipoma. This article aims to report a giant scrotal lipoma weighing 1100 g and illustrate our challenges with the diagnostic process in a low-resource setting. A 28-year-old male presented with a huge right scrotal mass. Examination revealed the mass had no cough impulse. It was firm, non-tender and lobulated, with definite edges. Scrotal sonography was suspicious of lipoma. Intraoperatively, there was an encapsulated scrotal wall mass and an incidental inguinoscrotal hernia, content being the omentum. The scrotal mass was excised, hernia sac was ligated, and excised and the posterior wall was repaired. Histology confirmed the scrotal mass as a lipoma. Primary scrotal lipomas are rare but should be considered in the differential diagnosis of unusual scrotal masses. Ultrasonography is a useful diagnostic tool in resource-limited settings.

Sigmoid colon carcinoma-associated with an inguinal hernia.

Introduction: Inguinal hernias are common diseases in the population, and the prevalence of colorectal cancer has increased significantly in recent decades. However, the concomitant association of these two entities is rarely described in the literature. In most cases, due to the complex diagnosis, patients are treated in emergencies with obstruction or perforation. Nowadays, there is no established consensus on the best surgical approach when this association exists. Case Presentation: We report a case of an 84-year-old patient admitted to the emergency room with a chronic inguinoscrotal hernia, with signs of intestinal obstruction, being diagnosed in the preoperative period by computed tomography, a neoplasm of the sigmoid colon incarcerated in the hernial sac. The patient underwent radical oncologic surgical treatment and inguinal herniorrhaphy through two access routes, with good postoperative evolution and outpatient follow-up after sixteen months. Conclusions: The association between CRC and inguinal hernia is unusual, but the surgeons should keep this possibility in mind because the treatment must be aimed to accomplish a safe oncologic outcome and as optimal as possible hernia repair.

Inguinoscrotal hernias containing stomach: risk of emergency presentation.

Inguinoscrotal hernias are the commonest form of abdominal wall hernia, but for them to contain stomach is extremely rare. The management of these hernias can be very challenging owing to their acute nature of presentation and distortion of anatomy. Our aim was to systematically review the literature for all reported cases of inguinoscrotal hernias containing stomach. In turn we analysed patient demographics, site of hernia, presentation and treatment. Outcomes were reviewed where available. We conducted a systematic search of the PUBMED, Embase and Medline databases with a combination of keywords: Hernia AND (inguin* OR scrot*) AND (gastric OR gastro*). An author's own case has also been included. There were 20 case reports included in the review, plus the author's own case. They ranged in publication date from 1942 to 2020. Mean age at presentation was 71 years (range 49 to 87). All cases were male. In total, 62% (n = 13) of cases presented with combined symptoms of abdominal pain and vomiting, 48% (n = 10) presented with gastric outlet obstruction (GOO) and 48% (n = 10) presented with gastric perforation. All successfully treated cases with gastric perforation required a midline laparotomy approach, whereas 56% (n = 5) of patients in the GOO group were successfully treated conservatively. There were three deaths reported in this review, all in the gastric perforation group. Stomach as a content of inguinoscrotal hernias is extremely rare. These hernias predominantly present acutely in the form of GOO or gastric perforation. All patients with gastric perforation will require a midline laparotomy. Patients with GOO can be successfully managed either surgically or in selective cases with conservative management.

Bilateral giant inguinoscrotal hernia with hydrocele. A case report

Giant inguinoscrotal hernia (GIH) is a high morbidity and mortality disease. Giant inguinoscrotal hernia containing omentum, intestinal segments or urinary bladder is a challenging surgical disease. The patient was diagnosed with bilateral giant inguinoscrotal hernia at the age of 81. The case had 22 years history of this uncommon disease. Ultrasound revealed a voluminous hernia sac containing bowel loops, greater omentum, and hydrocele. According the new classification of GIH, the patient was type II. He underwent complete surgical hernioplasty involving omentectomy and orchiectomy. After the surgery, any emerging complications were closely monitored. When giant inguinoscrotal hernia is diagnosed, operation should be recommended immediately. Treatment procedure of hernia should be according the classification of GIH. The Lichtenstein tension-free technique seems to be the best surgical procedure for the patient who have bilateral hernia. It should be used whenever possible in such cases. The patients should be carefully follow up postoperative in terms of abdominal compartment syndrome and respiratory insufficiency.

Vesicocutaneous fistula following inguinoscrotal hernia repair: a case report

Introduction: A vesicocutaneous fistula (VCF) represents an abnormal association between the bladder and the skin's surface. VCF mostly present as a complication of the diseases and treatments. Maceration, difficulty in treating the infection, moisture-associated skin damage, malodor, inconveniences, and physical disability were the sign and symptoms of VCF besides the visible urine leakage. A vesicocutaneous fistula should be treated adequately when recognized due to it may give bothersome complaints, social effects, and a possibility of recurrence to the patients. Proper surgical interventions are imperative because VCF leads to life-threatening complications such as cancer and sepsis. In this case, we report a case of vesicocutaneous fistula following inguinoscrotal hernia surgical repair in a 63-years-old man in order to provide an overview of the management of patients in similar cases. Case Description A 63-years-old man with a history of strangulated hernia and underwent exploratory laparotomy and ileostomy two weeks ago. Intermittent small amounts of urine discharge from the left groin was developed eleven days after the operation. The vital sign was normal, with a physical examination revealed a wet postoperative wound at the left groin. Mild tenderness over the suprapubic area. The hematology tests were normal. Cystography with contrast revealed the contrast appears to fill the bladder, and there is neither extravasation of contrast from the bladder to the distal end of the fistulous tract. The result was confirmed as the multiple diverticles within vesica urinaria. Incision of VCF was performed, and the bladder was closed in two layers with 3-0 Chromic for the mucosa and running polyglycolic acid (vicryl) 2-0 for the muscular. Conclusion: Laparotomy should be performed with care, and the surgeon must be aware of possible organ trauma. In our patient VCF was treated by suturing the fistula after drainage.

The role of scrotal ultrasonography from infancy to puberty.

BackgroundScrotal ultrasonography is an essential diagnostic tool in daily clinical practice. The availability of new‐generation ultrasound machines characterized by clearly improved image quality, low health cost, and higher patient safety, represents only some characteristics of ultrasound investigation. The usefulness of scrotal ultrasonography is particularly evident in the period of life from infancy to puberty, during which males undergo important morphofunctional changes, and several pathological conditions may occur.ObjectivesThis pictorial review primarily aimed to investigate the aspects of ultrasonography related to the normal physiological development of the gonads from mini‐puberty to pubertal onset. This study also aimed to provide an update on the use of ultrasonography in main andrological pathologies that may occur during this period. The conditions that are discussed in depth are: cryptorchidism, inguinoscrotal hernias, and hydrocele in the neonatal phase; acute scrotum, epididymo‐orchitis, and testicular cancers in childhood; and hypogonadism, varicoceles, testicular microlithiasis, and oncohematological pathology in puberty.DiscussionWe provided an ultrasound slant for all the above‐mentioned pathologies while purposely avoiding excessive deepening of the pathogenetic, clinical, and therapeutic aspects. Studying the ultrasound aspects of the gonads also facilitates differential diagnosis between various conditions and represents a good aid in evaluating therapeutic success (e.g., in hypogonadism or postsurgical evaluation of varicoceles and cryptorchidism).ConclusionScrotal ultrasonography is now globally recognized as the necessary completion of clinical–laboratory overview in gonads evaluation. This diagnostic procedure is even more indispensable in the infancy–childhood–puberty period for the evaluation of normal gonadal development as well as diagnosis of other possible diseases.

Closed non-suction drain placement as haematoma and seroma formation preventive measure post-nylon darn surgery for inguinoscrotal hernias in adults

PurposeInguinal hernia is a common male surgical disease. Intervention carries a wide range of complications such as scrotal haematoma and seroma which may require surgical re-intervention or predispose patients to developing infections, pains or feeling of mass. This could lead to long hospital stay. Scrotal tamponade by bandaging or wearing of tight pants and elevation are practiced to reduce bleeding and haematoma formation. These methods require prolong use. Closed suction drains are scarcely used in resource-deprived communities due to high cost and non-availability.AimThis study was to determine the effectiveness of a closed non-suction drain in preventing scrotal collection requiring further surgical intervention and the predisposition to developing surgical site infection following nylon darn repair of inguinoscrotal hernia.MethodsForty (40) participants were recruited for a preliminary study and assigned into control and interventional groups (CG, IG) for purposes of inserting flexible feeding tube (FFT) wound drain after nylon darn (ND) repair. Daily measurement of drained scrotal collection was carried out in the IG till the day drainage was zero. Residual volumes in IG and wound collection in the CG who were not candidates for re-intervention were determined at 14th and 28th post-operative days using ultrasound scan. Data were analyzed using SPSS version 25.ResultsThree (3) patients (15.8%) in the CG required re-intervention. Surgical site infection rates for the CG and IG were, respectively, 2/19 versus 0/21 (ρ = 0.134).There was a numerical significant difference in the mean volumes of scrotal collections between the control (0.95 ± 0.42 ml) and the intervention group (0.44 ± 0.33 ml) [p value of 0.041] but with no clinical impact.ConclusionSimple inexpensive flexible feeding tube placement significantly reduced scrotal collection which forms a base for larger sample size in subsequent studies. This could reduce the feared risk of re-intervention, wound infection and long hospital stay post-operative.

Non-infectious complications of peritoneal dialysis and peritoneal scintigraphy

Peritoneal dialysis (PD) is an alternative to hemodialysis that is indicated in patients with chronic end-stage disease. It has many advantages, but also complications such as dialysate leaks around the catheter insertion site, in the abdominal wall or in the pleural cavity, inguinoscrotal hernia and even intra-abdominal fluid collection.
 Peritoneal scintigraphy is a simple, non-invasive, low-irradiation examination, without the risk of allergy, that allows both diagnosing and locating these complications because it allows acquiring images at the time of infusion, as well as remotely and after drainage of the dialysate. Tomoscintigraphy coupled with scanner SPECT / CT (Single Photon Emission Computed Tomography / Computed Tomography) can also help narrow the diagnosis.
 The objective of this article is to clarify the value of peritoneal scintigraphy in the diagnosis of non-infectious complications of peritoneal dialysis, the conditions for performing the examination and the potential indications, as illustrated by a few cases.

Giant Inguinoscrotal hernia -a radiological perspective

Inguinal hernia is a common surgical disease. Giant inguinoscrotal hernias are more unusual and impose significant impact on quality of life including difficulty with mobility, scrotal skin ulceration and bowel obstruction. Besides it is more challenging in terms of surgical management. Diagnosis of giant inguinoscrotal hernia is straight forward on clinical examination. Nevertheless, with the advent of CT scan, pre-operative contrast-enhanced CT scan is useful for ascertaining the hernia contents, its configuration and measuring the neck of hernia. We report a case of a patient with extremely huge irreducible right giant inguinoscrotal hernias.

How to do a combined endoscopic and tailored open extraperitoneal approach for large congenital inguinoscrotal hernia.

Large inguinoscrotal hernias require experienced and skilful laparoscopic hernia surgeons to reap the benefits of laparoscopic versus open surgery. We advocate for an alternative hybrid TEP-open technique that allows tissue extraction away from the groin area, whenever necessary, thus avoiding more painful conventional open herniorrhaphy incision.

730 An Atypical Presentation of a Hernia: Gastro-Inguinal Hernia

Abstract Acute presentation of an inguinal hernia is a common presentation to general surgery in the United Kingdom (UK). Rarely intra-abdominal organs, outside of small bowel and colon, can present within an inguinal hernia e.g., appendix or bladder. There has been limited publication involving an incarcerated hernia containing the stomach. We present the case of an 84-year-old male with a background of COPD and hypertension who presented to Accident & Emergency with a three-day history of vomiting and diffuse abdominal pain. On examination, the patient had a distended abdomen with generalized peritonitis, and an irreducible non-tender inguinoscrotal hernia. A CT scan of the abdomen and pelvis demonstrated small bowel obstruction and gastric outlet obstruction secondary to a large incarcerated right inguinal hernia containing stomach. The patient rapidly deteriorated clinically, which led to a decision to palliate the patient. The patient died eight days after initial presentation. The cause of death was documented as likely perforated viscus in an inguino-scrotal hernia. This case illustrates the devastating prognosis of an acute presentation of an inguinal hernia containing the stomach. This should be considered a surgical emergency and immediate operative intervention should take place if the patient is clinically able to have surgery.