Massive Inguino-scrotal Hernia
Inguinal hernia is very common worldwide. In low- and middle-income countries, the estimated repair rate is 30 per 100,000 population per year.
Definition. Kingsnorth H3 and H4 hernias that are 20–30 cm below the pubic crest are massive. Massive hernias are associated with loss of domain as abdominal contents lie in the hernia sac over time. These massive hernias often cause difficulty in walking, sitting or lying down, with mobility dramatically restricted. These hernias are repaired with the patient in the standard prone position with general anaesthesia and endotracheal intubation. The standard oblique groin incision that is extended 1 or 2 cm beyond the pubic tubercle onto the crest adequately exposes the mass of tissue entering the scrotum.
Operative steps: The inguinal canal is opened in the standard manner. The internal ring is extended lateral, and the hernia is reduced. If this fails, an omentectomy and/or a colectomy is performed.
The posterior wall is repaired with the Lichtenstein procedure. Preoperative progressive pneumoperitoneum and plastic techniques or procedures may be used to increase the capacity of the abdominal cavity and prevent postreduction intra-abdominal hypertension.
Closure: The groin and the lower abdominal incisions are closed in the standard manner.
Post-operative management: In the immediate post-operative hours, the blood pressure, the urine output and the nasogastric aspirate have to be closely monitored.