Hybrid Laparoscopic-Open-Laparoscopic Repair for a Large Recurrent Inguinoscrotal Hernia: A Case Report

Recurrent inguinoscrotal hernias with visceral involvement present significant technical challenges, particularly when dense adhesions and large hernia sacs limit safe laparoscopic dissection. We report the case of a 55-year-old man with a large recurrent right inguinoscrotal hernia containing predominantly small bowel loops following previous open bilateral inguinal hernia repair. Preoperative computed tomography demonstrated bowel herniation with features suggestive of early incarceration. Surgery was initiated laparoscopically, allowing safe reduction of the herniated bowel and assessment of bowel viability. Due to dense adhesions and difficulty dissecting the large hernia sac laparoscopically, a limited open inguinal approach was performed for controlled sac dissection, followed by laparoscopic posterior mesh placement. This laparoscopic-open-laparoscopic hybrid approach provided a safe and effective solution, combining the benefits of minimally invasive assessment with secure open sac management, and should be considered in complex recurrent inguinoscrotal hernias when laparoscopic sac dissection is unsafe.