Repair of a Giant Inguinal Hernia Without Loss of Intra-Abdominal Domain.

Gretchen Aquilina, DO, Roy Sandau, DO, Alia Abdulla, DO. UMDNJ-SOM

OBJECTIVES:
While minimally invasive techniques are now favored by many surgeons and requested by many patients, there is still great importance of knowing the foundation of open surgical techniques. A 60 year old male with an impressive giant incarcerated inguinal hernia requested elective repair. The scrotum had multiple weeping ulcers, was larger than a basketball and extended down to the level of the patients knees. A pre-operative CT scan revealed the hernia contained colon and omentum compromising a large portion of his intra-abdominal domain. A successful repair of the hernia and restoration of the abdominal contents into their normal anatomic location is presented.
METHODS:
The hernia repair was completed following a transverse left inguinal incision. First a large hydrocele was drained. Careful dissection freed the hernia sac which contained segments of sigmoid colon and a large amount of omentum. Lysis of adhesions allowed the colon to be reduced back into the abdomen without bowel resection. A partial omentectomy was performed and redundant hernia sac amputated. The testicles were identified and preserved. The hernia was then repaired with biologic mesh in a tension free manner.
CONCLUSIONS:
By instituting the classic techniques of open hernia repair, a giant inguinal hernia was successfully repaired with restoration of the colon into the abdomen cavity. The patient suffered no post-operative complications and did not require any scrotoplasty.