Menenakos Charalambos, Albrecht Hendrik C, Gretschel Stephan
Department of General and Visceral Surgery, Brandenburg Medical School, University Hospital Neuruppin, Neuruppin, Germany.
J Surg Case Rep. 2020 Mar 6;2020(3):rjaa012. doi: 10.1093/jscr/rjaa012. eCollection 2020 Mar.
Giant inguinoscrotal hernia is typically defined as hernia extending below the midpoint of the inner thigh, in the standing position. These hernias can be a demanding surgical problem as replacing bowel contents into the abdomen that can cause a life-threatening increase in intra-abdominal pressures. Various techniques such as preoperative progressive pneumoperitoneum (PPP), debulking of abdominal contents with visceral resections with or without omentectomy and phrenectomy have been suggested. We report the case of a 65-year-old patient with giant bilateral inguinal hernia. We applied a novel two-stage combined approach consisting of PPP with simultaneous single shot injection of botulinum toxin Type A into the anterior abdominal wall, and a second stage laparotomy with hernia repair (Stoppa technique). This technique makes possible the successful treatment of giant inguinal hernias without the need for visceral resection. To our knowledge, this is the first presented case of this combined treatment modality.
巨大腹股沟阴囊疝通常定义为在站立位时疝囊延伸至大腿内侧中点以下。这些疝可能是具有挑战性的外科问题，因为将肠内容物回纳至腹腔会导致腹内压危及生命地升高。已提出多种技术，如术前渐进性气腹（PPP）、通过行或不行大网膜切除术及膈切除术的内脏切除术来减少腹腔内容物。我们报告一例65岁双侧巨大腹股沟疝患者的病例。我们采用了一种新颖的两阶段联合方法，包括PPP并同时向前腹壁单次注射A型肉毒杆菌毒素，以及第二阶段的疝修补剖腹手术（Stoppa技术）。该技术使得无需进行内脏切除术即可成功治疗巨大腹股沟疝。据我们所知，这是首例采用这种联合治疗方式的病例。
