達文西經腹腔腹膜前疝氣腹腔鏡修補術治療雙側巨大腹股溝疝氣: 個案報告及文獻回顧

許靖承 劉冠麟 林政鋒 林承家 陳文祥 吳翊豪 楊昀達 陳鴻毅

基隆長庚醫院 外科部 泌尿科

Robotic assisted trans-abdominal pre-peritoneal inguinal hernia repair for bilateral giant inguinoscrotal hernia

Ching-Cheng Hsu, Kuan-Lin Liu, Cheng-Feng Lin, Cheng-Chia Lin, Wen-Hsiang Chen, Yi-Hao Wu, Yun-Da Yang, Hong-Yi Chen

Divisions of Urology, Department of Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan

Introduction:

Giant inguinoscrotal hernia was a rare disease defined as hernias extending below the midpoint of the inner thigh, in the standing position. Which was a challenging surgical pathology. In this article we described a case of bilateral giant inguinal scrotal hernia managed by robotic assisted trans-abdominal pre-peritoneal(TAPP) hernia repair.

Case presentations:

We present a case of 73-year-old male with giant inguinalscrotal hernia surgically managed by robotic assisted TAPP. The patient reported he had lived with right side giant-scrotal hernia for 20 years. In the past year, progression of left side scrotal hernia was noted. The symptoms accompanied with intermittent abdominal cramping pain and functional gastrointestinal symptoms and skin erosion over right scrotal. He went to urologic outpatient department for further survey. Physical examination showed bilateral huge scrotal mass unreducible. Abdominal CT with contrast showed bilateral inguinal hernia (17 and 18 cm) with ileum, ascending colon, descending and sigmoid colon was noted with no evidence of ischemia. The patient had history of Type II Diabetes mellitus under medication control. Pre-operative lab data showed normocytic anemia. Robotic assisted TAPP was performed. The operation time was 12 hours. Intensive care treatment was not needed after operation. Patient had seromas formation managed conservatively. Patient discharged on post-operative day 6. Further follow-up will be arranged.

Discussion:

Giant inguinoscrotal hernia defined as hernias extending below the midpoint of the inner thigh, in the standing position is a rare disease which often related with neglect for many years. The symptoms sometimes accompanied with voiding difficulties, functional gastrointestinal problem, pressure sore over scrotum. The contents of giant inguinoscrotal hernias are usually bowel and rarely stomach, bladder, ureter have been reported. Post-operative abdominal compartment syndrome is a serious complication due to sudden replacement of the large bowel contents. Recurrence is much higher in giant inguinoscrotal hernia, tension free mesh can reduce recurrences. To our knowledge, there were no gold standard surgical method for giant inguinoscrotal hernia. Through this review we found out that robotic assisted TAPP might be a safe and feasible surgical method for giant inguinoscrotal hernia.

Conclusion:

Robotic assisted TAPP might be a feasible surgical method for bilateral giant inguinoscrotal hernia.