Retractile spermatic cord hernia: An unusual case report

Retractile spermatic cord hernia is an extremely rare type of inguinal hernia in which the herniated contents are located posterior to the spermatic cord, rather than passing anterior to it into the scrotum or medial thigh as in typical cases. To date, no case reports have described laparoscopic treatment of retractile spermatic cord hernia. This study presents a complete surgical case, highlighting the rarity of this condition and providing valuable reference for surgical decision-making in similar clinical scenarios.

A 59-year-old male presented with a 1-year history of left inguinal discomfort and swelling. He recently noticed a recurrent lump in the same region without systemic symptoms such as fever or gastrointestinal disturbance.

Ultrasonography confirmed the diagnosis of a left inguinal hernia. During surgery, a retractile hernia sac was found posterior to the spermatic cord, located near the left inferior epigastric vessels, and containing extraperitoneal fat and peritoneum.

The patient underwent total extraperitoneal laparoscopic hernia repair under general anesthesia. Dissection of the hernia sac was performed carefully, and a Bard 3DMax™ lightweight mesh was placed to reinforce the preperitoneal space.

The surgery was completed successfully without intraoperative or postoperative complications. The patient recovered well, and no recurrence was observed during follow-up.

Retractile spermatic cord hernia is clinically rare and can be easily confused with common inguinal hernias, often being diagnosed only intraoperatively. Total extraperitoneal laparoscopic hernia repair provides a clear operative field and facilitates rapid postoperative recovery. Increased awareness of this hernia type and accurate intraoperative identification are crucial for preventing tissue injury and optimizing surgical decision-making.