Zuvela Milan, Galun Danijel, Bogdanovic Aleksandar, Palibrk Ivan, Djukanovic Marija, Miletic Rade, Zivanovic Marko, Zuvela Milos, Zuvela Marinko
Clinic for Digestive Surgery, First Surgical Clinic, University Clinical Center of Serbia, Koste Todorovica 6, 11000, Belgrade, Serbia.
Hernia Center Žuvela, 11000, Belgrade, Serbia.
Hernia. 2024 Dec 20;29(1):50. doi: 10.1007/s10029-024-03242-2.
Management of giant inguinoscrotal hernia (GIH) is still a challenging procedure associated with a higher risk of intraabdominal hypertension and abdominal compartment syndrome as a life-threatening condition. The aim of the study was to present our management strategy for GIH.
This is a retrospective review of a case series including 24 consecutive patients with 25 GIH who underwent reconstructive surgery from January 2006 to June 2023, at the University Clinic for Digestive Surgery and Hernia Center Zuvela. A combined surgical strategy was applied: the modified Rives repair for groin hernias alone, Rives combined with organ resection to reduce hernia contents, and Rives combined with procedures for abdominal cavity enlargement. A surgical approach was defined based on the patient's general health, the volume of the hernia sac, and perioperative parameters.
All patients were male aged between 43 and 82 years. Rives was the only procedure in 12 patients. In addition to Rives, omentectomy was performed in four patients and intestinal resection in one. Abdominal cavity enlargement was performed following Rives hernioplasty in 9 patients. The median operative time was 215 min (range, 70-720). Surgical complications occurred in seven patients. In-hospital mortality was 12.5%. There was no groin hernia recurrence.
Our strategy is a single-stage treatment including modified Rives repair with or without additional procedures for abdominal cavity enlargement or hernia volume reduction, tailored to the individual patient characteristics. The procedure is associated with a higher risk of major morbidity requiring a well-trained intensive care unit team.
巨大腹股沟阴囊疝（GIH）的治疗仍是一项具有挑战性的手术，该手术与腹内高压和腹腔间隔室综合征这一危及生命的状况的较高风险相关。本研究的目的是介绍我们对GIH的治疗策略。
这是一项对病例系列的回顾性研究，纳入了2006年1月至2023年6月在祖韦拉大学消化外科诊所和疝中心连续接受重建手术的24例患者的25例GIH。采用了联合手术策略：单独对腹股沟疝进行改良里夫斯修补术，里夫斯修补术联合器官切除以减少疝内容物，以及里夫斯修补术联合腹腔扩大手术。根据患者的一般健康状况、疝囊大小和围手术期参数确定手术方法。
所有患者均为男性，年龄在43至82岁之间。12例患者仅接受了里夫斯修补术。除里夫斯修补术外，4例患者进行了网膜切除术，1例患者进行了肠切除术。9例患者在里夫斯疝修补术后进行了腹腔扩大手术。中位手术时间为215分钟（范围70 - 720分钟）。7例患者发生手术并发症。住院死亡率为12.5%。无腹股沟疝复发。
我们的策略是单阶段治疗，包括根据患者个体特征进行的改良里夫斯修补术，可选择或不选择额外的腹腔扩大或疝体积减小手术。该手术与较高的严重并发症风险相关，需要训练有素的重症监护病房团队。
