The re-introduction of herniated bowel back into the abdominal cavity due to a large, scrotal hernia will alter many aspects of a patient’s cardio-pulmonary and vascular systems. In addition, placing them under a general anesthesia will affect their peri-operative and post-operative course. The surgeon who is tackling this type of hernia will need to coordinate numerous pre-operative and post-operative consults. Progressive Pneumoperitoneum is a technique and when combined with Botulinum Toxin A (Botox) can increase the abdominal wall musculature length acting as a chemical component separation. Performance of a robotic inguinal hernia should be the same as described by many authors and may need to be modified to accommodate the additional intestines into the abdominal cavity. Complications need to be monitored for and post-operative Intensive Care Unit is frequently necessary. Large scrotal hernias can be approached using robotic and laparoscopic techniques but preparation is paramount to a successful repair, no matter what technique or approach is selected.
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A special thanks to Charlotte Klienman and Simone Baldeon, at the Baptist Health Library for their assistance with this chapter.
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