One stage repair of giant inguinal herniae: a feasible option

Background Surgical repair of giant inguino-scrotal hernia (GIH), based mainly on anatomical considerations and minimal organ resection; without the use of mesh or pneumo-peritoneum. Patients/method Over a-15-year period (2005-2019), all patients managed for GIH were reviewed. They had an elevation of the scrotum, and foot of the bed, to allow for the reducible part of the hernia to gradually return and expand the abdominal cavity. Volume estimations of the hernias were done applying Archimedes' principle followed by a-5-day bowel preparations. Abdomino-inguinal/Inguinal incisions (depending on the size), were made to repair the hernias taking advantage of the special anatomical make-up of the abdominal cavity. Results A total of 20 male patients with GIH were treated; 13 were on the right while seven were left-sided. All the GIHs were repaired successfully without any serious morbidity; one patient had a scrotal hematoma that was managed conservatively and another developed a ventral hernia (5 cm long), which was repaired at a later day. An average of 6 months follow-up revealed no recurrence or any other complications. Conclusion Surgical techniques in the repair of GIH are many and varied but its rarity has made the adoption of any specific technique(s) impossible. A fairly large series like ours over many years might be a fruitful attempt at solving this problem.