Tailored Laparoscopic Approach in Large Inguino-Scrotal Hernias: An Institutional Review

Eva Lourdes, Lynette Mee Ann Loo, Rakesh Gupta, Siau Wei Tang, Jesse Hu, Wee Boon Tan, Davide Lomanto, Prof. Minimally Invasive Surgery Centre, Department of Surgery, National University Health System, Singapore

Introduction: Since 2 decades laparoscopic hernia repair has gained a key role in uncomplicated inguinal hernia surgery with advantages showed by several trials and guidelines. However, its role in complicated inguinal hernia as incarcerated, obstructed and inguino-scrotal is still debatable even though a clear role as diagnostic tools is claimed. In particular, case of large inguino-scrotal evokes vehement objections to a laparoscopic procedure because of the anticipated problems and complications in dissecting the extended hernia sac even though a posterior approach has been advocate as repair of choice for complicated cases. In this study, we reviewed our series of patients undergoing Endo-laparoscopic repair of large inguino-scrotal hernias in a limited period of time.

Method: Between March 2013 and July 2015, 50 patients with inguino-scrotal hernias underwent laparoscopic inguinal hernia repair. Patient demographics, hernia characteristics, operating time, surgical technique, conversion rate, intraoperative and postoperative complications and recurrence were recorded, measured and analyzed using MS Excel software.

Result: 50 patients who underwent laparoscopic inguinal hernia repair were recorded, 47 patients underwent total extraperitoneal (TEP) inguinal hernia repair and 3 patients underwent transbdominal pre-peritoneal (TAPP) inguinal hernia repair. 26 patients had unilateral hernia and 24 patients had bilateral hernias. The mean age was 45 years old (range 18-72 years). The mean operation time was 74 min (range 46-102 min) for unilateral hernia and 116.5 mins (range 55-178 mins) for bilateral hernia. Three patients (6%) required a combined open surgery to transect the incarcerated omentum. There was no mortality. Morbidity was limited to seroma formation in 13 (26%) patients, 2 patient of the combined laparoscopic-open approach had wound infection treated with dressing and antibiotics, and 1 had orchitis. Mean Follow up was 26 ½ weeks (range 1-52 weeks). There were no recurrences (4.8%). All patients were discharged within 23 hours

Conclusion: We conclude that laparoscopic TEP can be safely employed for the treatment of complicated inguinal hernias as inguino-scrotal; surgical experience in endolaparoscopic hernia repair is mandatory with tailored technique in order to reduce to minimum morbidity and to achieve good clinical outcomes with acceptable recurrence rates.