Regarding extremely large inguinal hernias with a contribution of two cases

Area of Science:

• Surgery
• Gastroenterology

Background:

• Giant inguinoscrotal hernias present complex surgical challenges, often requiring specialized techniques for effective repair.
• Management necessitates a tailored, interdisciplinary approach considering patient-specific conditions and available therapeutic options.

Observation:

• Two male patients, aged 62 and 80, with giant inguinoscrotal hernias underwent single-stage repair.
• Surgical approaches included extended preperitoneal (Nyhus) and inguinal methods, utilizing a large policaproamide antimicrobial mesh (Ampoxen) with Stoppa's technique.
• Synchronous orchiectomy and transscrotal drainage were performed. One patient also had an umbilical hernia repaired, with the other having scrotal skin cellulitis impacting preparation.

Findings:

• The use of a large mesh (20 x 30 cm) facilitated acceptable intra-abdominal pressure post-repair.
• Operating without preoperative pneumoperitoneum in the second patient eased hernia content mobilization and reduction.
• Single-stage repair, including mesh reinforcement and synchronous procedures, proved effective for complex hernia cases.

Implications:

• These findings highlight the feasibility of single-stage repair for giant inguinoscrotal hernias using advanced mesh techniques.
• Individualized treatment strategies and interdisciplinary collaboration are crucial for optimizing outcomes in complex hernia surgery.
• The study underscores the importance of adapting surgical plans based on patient comorbidities, such as scrotal skin integrity.