Role of Laparoscopy in Inguinal Hernias with Loss of Domain

Lashondria Simpson, MD, Seth A Spector, MD, Alberto Iglesias, MD, Vincent DeGennaro, MD, Mark Kligman, MD, Emanuele Lo Menzo, MD PhD. University of Maryland, Baltimore, MD & University of Miami. Miami, FL USA

Introduction:
Repair of giant inguinal hernias pose a challenge to surgeons. Preoperative progressive pneumoperitoneum has been established as a valid method to re-establish domain. We describe the role of laparoscopy in two of these challenging cases.
Methods:
Case 1:
A 61-year old was referred to us for treatment of a massive right inguinal hernia with loss of domain. The hernia contained almost the entirety of the small bowel, the right colon, and bladder. The patient over the years developed chronic renal insufficiency from chronic ureteral obstructions.
Case 2:
A 50 year old male presented with a long standing history of a now symptomatic left giant inguinal hernia. His preoperative CT scan revealed a hernia containing almost all abdominal viscera except for the stomach, duodenum and rectum.
Results:
A chemotherapy port was implanted under laparoscopic guidance in order to achieve progressive preoperative pneumoperitoneum. Preoperative CT scan measurement confirmed the achieved compliance of the peritoneal cavity. Laparoscopic component separation was necessary in 1 case. Open repair with scrotoplasty was successful in both cases. The only intraoperative complication included a bladder injury, which was repaired without consequences. One mesh infection was treated non-operatively. Follow-up at 20 and 2 months respectively reveals no recurrence.
Conclusions:
Laparoscopy has a role in the first stage, but also during the repair of these complex hernias.