Cuihong Jin, Fan Wang, Yingmo Shen
Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital MedicalUniversity, Beijing, 100043, China.
Hernia. 2024 Dec 17;29(1):48. doi: 10.1007/s10029-024-03248-w.
Giant inguinoscrotal hernia (GISH) is a rare condition in high-income regions, and the management presents a significant challenge for surgeons. A retrospective analysis was conducted of a single center's experience in treating GISH by Lichtenstein approach. The objective was to gain insight into the characteristics of GISH and assess the clinical efficacy of the Lichtenstein approach, as well as the degree of improvement in patient quality of life (QoL).
Data from consecutive GISH patients who had undergone Lichtenstein repair at our institution from December 2018 to December 2023 were prospectively collected. The control group for the 1:2 matched case-control study was selected from pure inguinal hernia patients who underwent Lichtenstein repair during the same period. The demographics and surgical characteristics were analyzed. QoL and surgical satisfaction were respectively evaluated using the Carolina Comfort Scale and Numerical Rating Scale.
A total of 51 patients with GISH who underwent Lichtenstein repair were identified, and 102 patients with a pure inguinal hernia who underwent Lichtenstein repair were included in the control group. Patients in the GISH group exhibited a higher BMI than those in the control group; they also had a significantly longer hernia duration and a higher incidence of irreducible bulge. Additionally, the GISH patients had significantly higher ASA scores. All the Lichtenstein procedures were uneventful. There were more additional surgical procedures in GISH group, including hernia sac resection in 50 patients (98%) and adhesion release in 23 patients (45.1%). Five patients with GISH underwent omentectomy and one patient underwent testicular resection due to severe adhesions. The GISH group exhibited a higher incidence of postoperative complications. Five patients experienced urinary retention, and one intestinal obstruction. Two patients underwent surgical drainage under local anesthesia at one month postoperatively and made a full recovery. At six months postoperatively, the mean CCS score for the patients was 0.5 ± 0.8, with 21 patients (20.6%) scoring ≥ 2 out of the 23 categories. The results of the surgical satisfaction survey indicated that 130 patients (85.0%) gave a score of 5, reflecting high levels of satisfaction after Lichtenstein hernioplasty.
Patients with GISH typically have a long medical history, a high proportion of irreducible masses, and severe comorbidities, making surgery challenging. However, Lichtenstein repair remains a feasible and safe with high patient satisfaction and improved postoperative quality of life.
巨大腹股沟阴囊疝（GISH）在高收入地区是一种罕见疾病，其治疗对外科医生而言是一项重大挑战。本研究对单中心采用利氏修补术治疗GISH的经验进行回顾性分析。目的是深入了解GISH的特征，评估利氏修补术的临床疗效以及患者生活质量（QoL）的改善程度。
前瞻性收集2018年12月至2023年12月在本机构接受利氏修补术的连续性GISH患者的数据。1:2匹配病例对照研究的对照组选自同期接受利氏修补术的单纯腹股沟疝患者。分析人口统计学和手术特征。分别使用卡罗莱纳舒适度量表和数字评分量表评估QoL和手术满意度。
共确定51例接受利氏修补术的GISH患者，对照组纳入102例接受利氏修补术的单纯腹股沟疝患者。GISH组患者的BMI高于对照组；他们的疝病程也明显更长，不可复性肿块的发生率更高。此外，GISH患者的美国麻醉医师协会（ASA）评分明显更高。所有利氏手术均顺利完成。GISH组有更多的附加手术，包括50例（98%）疝囊切除术和23例（45.1%）粘连松解术。5例GISH患者因严重粘连接受大网膜切除术，1例患者接受睾丸切除术。GISH组术后并发症发生率更高。5例患者出现尿潴留，1例出现肠梗阻。2例患者在术后1个月接受局部麻醉下的手术引流，完全康复。术后6个月，患者的平均CCS评分为0.5±0.8，23个类别中有21例患者（20.6%）得分≥2分。手术满意度调查结果显示，130例患者（85.0%）给出5分，表明利氏疝修补术后患者满意度较高。
GISH患者通常病史较长，不可复性肿块比例高，合并症严重，手术具有挑战性。然而，利氏修补术仍然是可行且安全的，患者满意度高，术后生活质量得到改善。
