Regarding extremely large inguinal hernias with a contribution of two cases

We report two men of ages 62 and 80 years, respectively, with giant inguinoscrotal hernias. They were operated with a single-stage repair by two approaches, extended preperitoneal of Nyhus and an inguinal method. After hernia content reduction, a policaproamide antimicrobial mesh Ampoxen (MEDICA SA, Sandanski, Bulgaria) with dimensions 20 x 30 cm was inserted by using Stoppa's technique. An additional inguinal reinforcement with other mesh patch was done on the external aponeurosis hernial defect. Synchronous orchiectomy and transscrotal drainage of both patients was performed. The first patient suffering from umbilical hernia was also operated at the same stage. He was prepared by preoperative pneumoperitoneum. The second patient, due to scrotal skin cellulitis with ulceration, was operated without pneumoperitoneum preparation. The latter created easier mobilization and reduction of the hernial content. The sizable mesh dimensions allowed, to some degree, an acceptable level of intra-abdominal pressure after the repair. These hernias demand interdisciplinary teamwork and their treatment has to be adapted to the individual condition of the patient using all therapeutic options.