Miller Derek B, Reed Logan
College of Medicine, Florida State University, Tallahassee, FL, USA.
J Surg Case Rep. 2020 Dec 17;2020(12):rjaa511. doi: 10.1093/jscr/rjaa511. eCollection 2020 Dec.
Giant inguinoscrotal hernias, defined as the extension beyond the midpoint of the inner thigh, continue to require multi-step approaches due to their complexity. Although rare in developed countries, they are commonly present in rural areas after years of neglect. This consequently allows the abdomen to maladapt to lower volumes, creating a loss of domain. Here, we present a giant left inguinoscrotal hernia managed with a unique multi-stage approach, aimed to minimize commonly encountered perioperative complications associated with abdominal hypertension. The combined two-staged approach used begins with preoperative progressive pneumoperitoneum, followed by the combined procedures of laparotomy hernia repair (Stoppa technique) and transversus abdominis release, thereby promoting a tension-free closure that is able to accommodate the reduced contents. Various modalities used in treating these hernias have been previously described; however, to our knowledge, the combined use of techniques described here has not been reported.
巨大腹股沟阴囊疝被定义为疝内容物延伸至大腿内侧中点以外，因其复杂性，仍需要多步骤的治疗方法。尽管在发达国家较为罕见，但在农村地区，由于多年来未得到重视，这种疝很常见。这会导致腹部难以适应较小的容量，从而出现“失域”现象。在此，我们介绍一例采用独特多阶段方法治疗的巨大左侧腹股沟阴囊疝，旨在尽量减少与腹腔高压相关的常见围手术期并发症。所采用的联合两阶段方法首先是术前逐步气腹，然后是开腹疝修补术（Stoppa技术）和腹横肌松解术的联合操作，从而实现无张力缝合，以容纳缩小后的疝内容物。此前已有多种治疗这些疝的方法被描述；然而，据我们所知，此处所描述技术的联合应用尚未见报道。
