• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar
  • Skip to footer

SAGES

Reimagining surgical care for a healthier world

  • Home
    • COVID-19 Annoucements
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Who is SAGES?
    • SAGES Mission Statement
    • Advocacy
    • Strategic Plan, 2020-2023
    • Committees
      • Request to Join a SAGES Committee
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Full Committee Rosters
      • SAGES Past Presidents
    • Donate to the SAGES Foundation
    • Awards
      • George Berci Award
      • Pioneer in Surgical Endoscopy
      • Excellence In Clinical Care
      • International Ambassador
      • IRCAD Visiting Fellowship
      • Social Justice and Health Equity
      • Excellence in Community Surgery
      • Distinguished Service
      • Early Career Researcher
      • Researcher in Training
      • Jeff Ponsky Master Educator
      • Excellence in Medical Leadership
      • Barbara Berci Memorial Award
      • Brandeis Scholarship
      • Advocacy Summit
      • RAFT Annual Meeting Abstract Contest and Awards
  • Meetings
    • NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2023 Scientific Session Call For Abstracts
      • 2023 Emerging Technology Call For Abstracts
    • CME Claim Form
    • Industry
      • Advertising Opportunities
      • Exhibit Opportunities
      • Sponsorship Opportunities
    • Future Meetings
    • Past Meetings
      • SAGES 2022
      • SAGES 2021
    • Related Meetings Calendar
  • Join SAGES!
    • Membership Benefits
    • Membership Applications
      • Active Membership
      • Affiliate Membership
      • Associate Active Membership
      • Candidate Membership
      • International Membership
      • Medical Student Membership
    • Member News
      • Member Spotlight
      • Give the Gift of SAGES Membership
  • Patients
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Patient Information Brochures
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find a SAGES Member
  • Publications
    • SAGES Stories Podcast
    • SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Patient Information Brochures
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • SCOPE – The SAGES Newsletter
    • COVID-19 Annoucements
    • Troubleshooting Guides
  • Education
    • OpiVoid.org
    • SAGES.TV Video Library
    • Safe Cholecystectomy Program
      • Safe Cholecystectomy Didactic Modules
    • Masters Program
      • SAGES Facebook Program Collaboratives
      • Acute Care Surgery
      • Bariatric
      • Biliary
      • Colorectal
      • Flexible Endoscopy (upper or lower)
      • Foregut
      • Hernia
      • Robotics
    • Educational Opportunities
    • HPB/Solid Organ Program
    • Courses for Residents
      • Advanced Courses
      • Basic Courses
    • Video Based Assessments (VBA)
    • Robotics Fellows Course
    • MIS Fellows Course
    • Facebook Livestreams
    • Free Webinars For Residents
    • SMART Enhanced Recovery Program
    • SAGES OR SAFETY Video
    • SAGES at Cine-Med
      • SAGES Top 21 MIS Procedures
      • SAGES Pearls
      • SAGES Flexible Endoscopy 101
      • SAGES Tips & Tricks of the Top 21
  • Opportunities
    • NEW-Area of Concentrated Training Seal (ACT)-Advanced Flexible Endoscopy-Coming Soon!
    • SAGES Fellowship Certification for Advanced GI MIS and Comprehensive Flexible Endoscopy
    • Multi-Society Foregut Fellowship Certification
    • SAGES Research Opportunities
    • Fundamentals of Laparoscopic Surgery
    • Fundamentals of Endoscopic Surgery
    • Fundamental Use of Surgical Energy
    • Job Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
  • Store
    • “Unofficial” Logo Products
  • Log In

Giant Inguinal Hernia with Loss of Abdominal Domain

Adam S Weltz, MD1, Zachary Sanford, MD1, Devinder Singh2, Robert Hanley3, David Todd4, Igor Belyansky1. 1Department of Surgery, Anne Arundel Medical Center, 2Department of Plastic Surgery, Anne Arundel Medical Center, 3Department of Urology, Anne Arundel Medical Center, 4Department of Radiology, Anne Arundel Medical Center

Introduction: Giant inguinoscrotal hernias (GIH) are groin hernias that extend below the mid-thigh when standing, negatively impacting daily activity.  To date there are no reports utilizing progressive pneumoperitoneum (PP), botulinum toxin A injection (BTI), and enhanced view-totally extraperitoneal technique (eTEP) on the same patient at time of GIH repair.  In this report we present a unique minimally invasive multi-disciplinary approach to address GIH.

Case Presentation: A 59-year-old gentleman presented with lifelong bilateral inguinal hernias and a right hernia that enlarged such that the distal-most aspect of the hernia sac nearly reached the floor when standing.  Additionally there was a voluminous accumulation of ascitic fluid in the sac as well as the entirety of his small intestine and majority of his colon.  As a result, he had complete loss of abdominal domain.  Surprisingly, he had no other major medical co-morbidities on preoperative evaluation.

Four weeks before surgery botulinum toxin A was injected to facilitate abdominal wall musculature relaxation before peritoneal dialysis catheter was placed laparoscopically for progressive pneumoperitoneum to stretch the abdominal cavity, making room for the return of visera.  The following week a foley catheter was placed and cystoscopy performed before the eTEP procedure.  The left retrorectus space was developed under direct vision down to the space of Retzius, followed by release of the transversus abdominis muscle from cephalad to caudal direction and by contralateral crossover.  The space was developed from the subcostal region down to the myopectineal orifice.

We addressed the left side hernia first, with myopectineal orifice dissection performed.  Portions of the posterior lamella of left internal oblique and transversus abdominis were released.  We then reduced a large left cord lipoma.  12×16-cm mesh covered the myopectineal orifice.  Next, we explored the groin through a right incision, discovering a sliding hernia unable to be safely reduced laparoscopically.  The sac was sharply opened and distal portion ligated under direct vision with intestines successfully reduced.  The inguinal canal floor was closed then roofed with internal oblique muscle and transversalis fascia.  12×16 mesh was placed in the right groin covering the myopectineal orifice and 20×30-cm mesh covered the left and right hernia mesh to stabilize the abdominal wall.

Reconstruction including partial scrotectomy and scrotal plasty using adjacent tissue transfer technique was completed.  The patient tolerated the procedure well, was discharged home on POD 5, and seen in clinic one month postoperatively doing well with minimal scrotal swelling and no sign of recurrence. 


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 88250

Program Number: V093

Presentation Session: Plenary 1 Session

Presentation Type: Video

107

Share this:

  • Twitter
  • Facebook
  • LinkedIn
  • Pinterest
  • WhatsApp
  • Reddit

Related

« Return to SAGES 2018 abstract archive

Our Mission

Innovate, educate and collaborate to improve patient care.

Recently, on SAGES…

Critical View of Safety (CVS) Challenge QR Code

The SAGES Critical View of Safety Challenge – Donate Your Lap Chole Videos!

The Society of American Gastrointestinal and Endoscopic Surgeons is hosting the first Artificial Intelligence Data Challenge conducted by surgeons. The aim of this challenge is to generate a large and diverse dataset of laparoscopic cholecystectomy videos, annotated with respect to the subcomponents of the Critical View of Safety (CVS). Computer scientists from all over the […]

Respuesta de SAGES al Estudio NordICC sobre el beneficio de las colonoscopias de detección

SAGES desea aclarar los resultados del estudio NordICC y colocarlos en contexto de los esfuerzos de varias agencias nacionales para reducir el riesgo de cáncer colorrectal – la segunda causa de muerte por cáncer más frecuente en los Estados Unidos-, mediante la promoción de la detección y tratamiento oportuno de las lesiones.

SAGES Response to NordICC Study Regarding Benefit of Screening Colonoscopies

The NordICC Study recently published in The New England Journal of Medicine and widely reported on by media outlets has raised questions regarding the benefit of screening colonoscopy in lowering the risk of colorectal cancer and cancer-related deaths among otherwise healthy and symptom-free men and women aged 55 to 64. Provocative headlines and commentaries have […]

Contact SAGES

Society of American Gastrointestinal and Endoscopic Surgeons
11300 W. Olympic Blvd Suite 600
Los Angeles, CA 90064 USA
webmaster@sages.org
Tel: (310) 437-0544

Find Us Around the Web!

  • Facebook
  • Twitter
  • YouTube

Important Links

SAGES 2023 Meeting Information

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals

 

  • taTME Study Info
  • Foundation
  • SAGES.TV
  • MyCME
  • Educational Activities

Copyright © 2023 Society of American Gastrointestinal and Endoscopic Surgeons