Chinnusamy Palanivelu1, Muthukumaran Rangarajan2, Suviraj James John1. 1. GEM Hospital, 45-A Pankaja Mill Road, Ramnathapuram, Coimbatore, 641045, India. 2. GEM Hospital, 45-A Pankaja Mill Road, Ramnathapuram, Coimbatore, 641045, India. rangy68@gmail.com.
Abstract
INTRODUCTION: The surgical repair of large irreducible scrotal hernias is, in general, technically difficult. Laparoscopic repair for these cases is controversial, although extraperitoneal and transperitoneal approaches have been described. We present a small series of patients with large irreducible groin hernias (omentoceles) treated by laparoscopy and a modification to facilitate complete removal of the omentum from the sac. MATERIALS AND METHODS: We prefer laparoscopic transperitoneal repair for large irreducible scrotal hernias, with as much omentum as possible being excised. Then a small groin incision is made to excise the remaining omentum. RESULTS: All of the patients in this study were male, and their average age was 66 years (60-72 years). Eight patients presented with seromas at the first follow-up; three required repeated aspiration, and the rest resolved spontaneously. There were no cases of wound or mesh infection/migration or recurrence after a follow-up of 36 months. CONCLUSIONS: At the beginning of our experience, if these hernias could not be reduced, we converted to the open procedure. Now, using the modification with which we remove the adherent omentum from the distal sac, there are no conversions. This technique could make life easier for laparoscopic surgeons who attempt repair of large irreducible scrotal hernias, a not uncommon occurrence in developing countries.
INTRODUCTION: The surgical repair of large irreducible scrotal hernias is, in general, technically difficult. Laparoscopic repair for these cases is controversial, although extraperitoneal and transperitoneal approaches have been described. We present a small series of patients with large irreducible groin hernias (omentoceles) treated by laparoscopy and a modification to facilitate complete removal of the omentum from the sac. MATERIALS AND METHODS: We prefer laparoscopic transperitoneal repair for large irreducible scrotal hernias, with as much omentum as possible being excised. Then a small groin incision is made to excise the remaining omentum. RESULTS: All of the patients in this study were male, and their average age was 66 years (60-72 years). Eight patients presented with seromas at the first follow-up; three required repeated aspiration, and the rest resolved spontaneously. There were no cases of wound or mesh infection/migration or recurrence after a follow-up of 36 months. CONCLUSIONS: At the beginning of our experience, if these hernias could not be reduced, we converted to the open procedure. Now, using the modification with which we remove the adherent omentum from the distal sac, there are no conversions. This technique could make life easier for laparoscopic surgeons who attempt repair of large irreducible scrotal hernias, a not uncommon occurrence in developing countries.
Authors: Arianna Birindelli; Massimo Sartelli; Salomone Di Saverio; Federico Coccolini; Luca Ansaloni; Gabrielle H van Ramshorst; Giampiero Campanelli; Vladimir Khokha; Ernest E Moore; Andrew Peitzman; George Velmahos; Frederick Alan Moore; Ari Leppaniemi; Clay Cothren Burlew; Walter L Biffl; Kaoru Koike; Yoram Kluger; Gustavo P Fraga; Carlos A Ordonez; Matteo Novello; Ferdinando Agresta; Boris Sakakushev; Igor Gerych; Imtiaz Wani; Michael D Kelly; Carlos Augusto Gomes; Mario Paulo Faro; Antonio Tarasconi; Zaza Demetrashvili; Jae Gil Lee; Nereo Vettoretto; Gianluca Guercioni; Roberto Persiani; Cristian Tranà; Yunfeng Cui; Kenneth Y Y Kok; Wagih M Ghnnam; Ashraf El-Sayed Abbas; Norio Sato; Sanjay Marwah; Muthukumaran Rangarajan; Offir Ben-Ishay; Abdul Rashid K Adesunkanmi; Helmut Alfredo Segovia Lohse; Jakub Kenig; Stefano Mandalà; Raul Coimbra; Aneel Bhangu; Nigel Suggett; Antonio Biondi; Nazario Portolani; Gianluca Baiocchi; Andrew W Kirkpatrick; Rodolfo Scibé; Michael Sugrue; Osvaldo Chiara; Fausto Catena Journal: World J Emerg Surg Date: 2017-08-07 Impact factor: 5.469
Authors: Massimo Sartelli; Federico Coccolini; Gabrielle H van Ramshorst; Giampiero Campanelli; Vincenzo Mandalà; Luca Ansaloni; Ernest E Moore; Andrew Peitzman; George Velmahos; Fredrick Alan Moore; Ari Leppaniemi; Clay Cothren Burlew; Walter Biffl; Kaoru Koike; Yoram Kluger; Gustavo P Fraga; Carlos A Ordonez; Salomone Di Saverio; Ferdinando Agresta; Boris Sakakushev; Igor Gerych; Imtiaz Wani; Michael D Kelly; Carlos Augusto Gomes; Mario Paulo Faro; Korhan Taviloglu; Zaza Demetrashvili; Jae Gil Lee; Nereo Vettoretto; Gianluca Guercioni; Cristian Tranà; Yunfeng Cui; Kenneth Yy Kok; Wagih M Ghnnam; Ashraf El-Sayed Abbas; Norio Sato; Sanjay Marwah; Muthukumaran Rangarajan; Offir Ben-Ishay; Abdul Rashid K Adesunkanmi; Helmut Alfredo Segovia Lohse; Jakub Kenig; Stefano Mandalà; Andrea Patrizi; Rodolfo Scibé; Fausto Catena Journal: World J Emerg Surg Date: 2013-12-01 Impact factor: 5.469