Preperitoneal mesh hernioplasty in giant inguinoscrotal hernias: a new technique with dual benefit in repair and abdominal rooming.

To solve the problem of limited abdominal cavity in cases of giant inguino-scrotal hernias, a new technique is described, aiming, while repairing the hernia, to provide a larger abdominal cavity into which the hernial contents can be replaced without compromising respiratory and cardiac functions. The idea of this technique is to create a midline abdominal wall defect to increase the intra-abdominal capacity to accommodate the hernial contents. The hernial sac is then pulled up to the abdomen and fashioned as a rotation flap to augment and close the peritoneum over the replaced contents. Lastly, a giant Polypropylene mesh is inserted in the preperitoneal space to cover the created midline defect and to buttress both inguinal regions. Eight patients with giant inguinoscrotal hernias were operated upon using this technique. The results showed that the procedure is safe and all postoperative complications (three seromas, two wound infections, and two cases of severe scrotal edema) were treated conservatively. All patients were discharged home within 7-15 days and no recurrences have been reported in a follow-up period of between 2 and 4 years. In addition to repairing hernial defects, this new technique allows reduction of massive hernias without compromising respiratory and cardiac functions by enlarging the shrunken peritoneal cavity before returning the hernia's contents. Moreover, in covering the abdominal defect which has been created by the hernial sac, direct contact between the intestine and the mesh is prevented, thus minimizing the risk of adhesions and fistulas.