Lisheng Wu1*, Junsheng Li2, Jianwei Yu1 and Ran Miao1
1Department of Hernia and Metabolic Surgery, The First Affiliated Hospital, University of Science and Technology, China
2Department of General Surgery, Affiliated Zhongda Hospital, Southeast University, China
Background: Direct inguinal hernias rarely descend into the scrotum. We reported ten cases of direct inguinal hernias descending into the scrotums during inguinal hernia repair procedures. Methods: We reported a series of 10 cases of direct inguinal hernias which descending into the scrotums. 8 of the 10 cases were bilateral direct hernias, and 4 of the 10 cases were recurrent direct hernias. The direct-scrotal hernias were found in right side in 6 cases and left sides in 4 cases. The successful laparoscopic inguinal hernia repairs were performed in 6 these cases, and open repairs in 4 cases. And we presented the operative findings of the repair technique, illustrated the mechanism of direct hernia into scrotum, in addition, we also provided our skills and pitfalls in treating the hernias in this situation. Results: The both laparoscopic and open approaches were successfully performed in all cases, recurrent direct-scrotal hernias resulted heavy adhesion and made dissection difficult, the direct hernia sacs had a close contact with the vas deference by disrupting the transversalis fascia. Closing the large direct orifice prior to placement was a useful method to prevent recurrence. Conclusion: The extreme attenuation or disruption of the transversalis attribute to the occurrence of direct-scrotal hernias, therefore, the cord structures were exposed to the direct hernia defect and should be avoided during dissection and hernia repair. Closing of the transversalis fascia around the defect cavity prior to mesh placement is a reliable method to prevent hernia recurrence in this situation.
Direct inguinal hernia; Spermatic cord; Scrotum; TAPP; TEP
Wu L, Li J, Yu J, Miao R. The Intraoperative Findings and Clinical Experience of Direct Inguinal Hernia Descending into the Scrotum. Clin Surg. 2019; 4: 2535..