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Management of herniated retroperitoneal adipose tissue during endoscopic extraperitoneal inguinal hernioplasty

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Abstract

Background

Herniation of retroperitoneal adipose tissue into the inguinal canal, traditionally called cord lipoma, is frequently encountered during endoscopic totally extraperitoneal inguinal hernioplasty (TEP). Failure to recognize and manage the cord lipoma accounted for 30%–50% of recurrent hernia after TEP. The present study was undertaken to evaluate the incidence, risk factors, and management of herniated retroperitoneal adipose tissue during TEP.

Methods

Between December 2002 and November 2005 all patients who underwent TEP were prospectively evaluated for the presence of cord lipoma. Clinical outcomes of patients who were treated for their cord lipoma were compared with those without cord lipoma. Risk factors for the occurrence of cord lipoma were also examined.

Results

A total of 498 patients underwent unilateral (n = 386) or bilateral (n = 112) TEP. The overall incidence of cord lipoma was 26.5% (n = 132). A higher body weight, a higher body mass index, and a larger hernial defect were significantly associated with the presence of cord lipoma. Most of the cord lipoma cases (n = 119) were reduced to pelvic peritoneal reflection line after division of the feeding vessels from surrounding structures, while the rest (n = 13) were resected. Early postoperative outcomes, including pain score, morbidities, and other recovery variables, showed no significant difference between the two groups. No recurrence occurred in the present series.

Conclusions

Herniation of retroperitoneal adipose tissue into the inguinal canal occurred in more than one-fifth of the patients with inguinal hernia. Awareness and appropriate treatment of the cord lipoma helped to reduce the risk of recurrence. During TEP, the internal inguinal ring and inguinal canal should always be cleared of any herniated adipose tissue by either reduction or resection. This clearing posed no adverse effects on postoperative outcome.

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References

  1. Carilli S, Alper A, Emre A (2004) Inguinal cord lipomas. Hernia 8: 252–254

    Article  PubMed  CAS  Google Scholar 

  2. Crawford DL, Hiatt JR, Phillips EH (1998) Laparoscopy identifies unexpected groin hernias. Am Surg 64: 976–978

    PubMed  CAS  Google Scholar 

  3. De Luca L, Di Giorgio P, Signoriello G, Sorrentino E, Rivellini G, D’Amore E, De Luca B, Murray JA (2004) Relationship between hiatal hernia and inguinal hernia. Dig Dis Sci 49: 243–247

    Article  PubMed  Google Scholar 

  4. Fawcett AN, Rooney PS (1997) Inguinal cord lipoma. Br J Surg 84: 1169

    Article  PubMed  CAS  Google Scholar 

  5. Felix E, Scott S, Crafton B, Geis P, Duncan T, Sewell R, McKernan B (1998) Causes of recurrence after laparoscopic hernioplasty. A multicenter study. Surg Endosc 12: 226–231

    Article  PubMed  CAS  Google Scholar 

  6. Gersin KS, Heniford BT, Garcia-Ruiz A, Ponsky JL (1999) Missed lipoma of the spermatic cord. A pitfall of transabdominal preperitoneal laparoscopic hernia repair. Surg Endosc 13: 585–587

    Article  PubMed  CAS  Google Scholar 

  7. Hainsworth PJ (2000) A hernia sac cannot be found at operation [letter]. Br J Surg 87: 521

    Article  PubMed  CAS  Google Scholar 

  8. Heller CA, Marucci DD, Dunn T, Barr EM, Houang M, Dos Remedios C (2002) Inguinal canal “lipoma”. Clin Anat 15: 280–285

    Article  PubMed  Google Scholar 

  9. Lau H (2005) Fibrin sealant versus mechanical stapling for mesh fixation during endoscopic extraperitoneal inguinal hernioplasty: a randomized prospective trial. Ann Surg 242: 670–675

    Article  PubMed  Google Scholar 

  10. Lau H (2004) Sliding lipoma: an indirect inguinal hernia without a peritoneal sac. J Laparoendosc Surg Adv Surg Tech A 14: 57–59

    Article  Google Scholar 

  11. Lilly MC, Arregui ME (2002) Lipomas of the cord and round ligament. Ann Surg 235: 586–590

    Article  PubMed  Google Scholar 

  12. McDonnell CO, Walsh TN (2000) A hernia sac cannot be found at operation [letter]. Br J Surg 87: 521

    PubMed  CAS  Google Scholar 

  13. Nasr AO, Tormey S, Walsh TN (2005) Lipoma of the cord and round ligament: an overlooked diagnosis? Hernia 9: 245–247

    Article  PubMed  Google Scholar 

  14. Nyhus LM (1993) Individualization of hernia repair: a new era. Surgery 114: 1–2

    PubMed  CAS  Google Scholar 

  15. Read RC, Schaefer RF (2000) Lipoma of the spermatic cord, fatty herniation, liposarcoma. Hernia 4: 149–154

    Article  Google Scholar 

  16. Rosenberg N (1979) “Lipoma” of the spermatic cord: potential relationship to indirect inguinal hernia in adults. Arch Surg 114: 549–550

    PubMed  CAS  Google Scholar 

  17. Wilson LJ, Ma W, Hirschowitz BI (1999) Association of obesity with hiatal hernia and esophagitis. Am J Gastroenterol 94: 2840–2844

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

The authors acknowledge the kind assistance of Tze-Ching Tan, M.D., in editing the manuscript.

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Authors and Affiliations

  1. Department of Surgery, University of Hong Kong Medical Center, Queen Mary Hospital & Tung Wah Hospital, Hong Kong, SAR

    H. Lau, W. K. Yuen & N. G. Patil

  2. Department of Pathology, University of Hong Kong Medical Center, Queen Mary Hospital & Tung Wah Hospital, Hong Kong, SAR

    F. Loong

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  1. H. Lau
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  2. F. Loong
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  3. W. K. Yuen
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  4. N. G. Patil
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Correspondence to H. Lau.

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Lau, H., Loong, F., Yuen, W.K. et al. Management of herniated retroperitoneal adipose tissue during endoscopic extraperitoneal inguinal hernioplasty. Surg Endosc 21, 1612–1616 (2007). https://doi.org/10.1007/s00464-007-9205-0

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  • DOI: https://doi.org/10.1007/s00464-007-9205-0

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