Koller Alyssa, Oberholzer Jose, Rössler Fabian
Surgery and Transplantation, Universitätsspital Zürich, Zürich, CHE.
Cureus. 2024 Nov 27;16(11):e74599. doi: 10.7759/cureus.74599. eCollection 2024 Nov.
The surgical repair of giant inguinal hernias with loss of domain, defined as the relocation of the majority of the intestine into the hernia sac, poses a significant challenge. In the majority of cases, a combination of different surgical techniques with the placement of multiple meshes is necessary to achieve reduction of such complex hernias. The reduction of chronic giant hernias can increase the risk of abdominal compartment syndrome or cardiopulmonary complications. This case study presents a rare and complex case of a patient with a chronic giant inguinal hernia, in which almost the entire intestine was herniated, involving the scrotum and reaching mid thigh. The reduction of the hernia was achieved by a combined open transabdominal and inguinal approach, utilizing the abdominal component separation technique and multiple preperitoneal mesh placements. This multimodal approach resulted in optimal outcomes in terms of cosmesis, functionality, and abdominal wall integrity.
巨大腹股沟疝伴域缺失（定义为大部分肠管移位至疝囊）的手术修复是一项重大挑战。在大多数情况下，需要结合不同的手术技术并放置多个补片，才能实现此类复杂疝的还纳。慢性巨大疝的还纳会增加腹腔间隔室综合征或心肺并发症的风险。本病例研究展示了一例罕见且复杂的慢性巨大腹股沟疝患者，几乎整个肠管均发生疝出，累及阴囊并延伸至大腿中部。通过联合开放经腹和腹股沟入路，采用腹壁成分分离技术和多个腹膜前补片放置实现了疝的还纳操作。这种多模式方法在美容效果、功能和腹壁完整性方面均取得了最佳结果。
