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Case 68: Inguinoscrotal hernia

A 72 year old man with COPD has been tolerating a large right inguinoscrotal hernia for many years. He now finds that it is limiting his mobility and causing significant discomfort.

1. What concerns do you have for hernia repair in this man specifically?

This massive hernia obviously contains a significant volume of bowel. It may be difficult or impossible to return it to the true abdominal cavity. It will certainly lead to compromised ventilation from splinting of the diaphragm. In this man with COAD it could lead to respiratory failure and the back up of intensive care would certainly be required before attempting repair.

2. How would your technique for repair vary from your standard open approach?

Repair of this hernia will require major surgery with adequate planning of the surgical technique and peri-operative care. Complete reduction of the hernia may require laparotomy and a "relaxing" incision in the midline repaired with mesh to accomodate the bowel. Alternatively implantable tissue expanders or even controlled pneumoperitoneum have been used to gradually "stretch" the abdominal wall to increase its volume prior to repair of similar massive hernias.