Right Inguinoscrotal Hernia With Irreducible Sigmoid Neoplasm: Oncological Resection and Concomitant Complex Robotic Hernia Repair

Abstract Concomitant colorectal and hernia surgery is controversial due to the risk of infection in clean-contaminated or contaminated environments and morbidity, even in case of minimally invasive surgery. Occasionally, we may encounter patients with symptomatic inguinoscrotal hernia and colorectal cancer. We present a case of a 65 years-old male patient with a dolicosigmoid neoplasm found inside a large irreducible right inguinoscrotal hernia. Both complex procedures were performed by laparoscopy assisted by the robotic platform DaVinci. The uniqueness of this procedure lies in a modified trocar position (cranial than standardized) to allow their use for both complex procedures. After hernia reduction, a standard robotic TAPP with polypropylene mesh was performed at first to reduce the possibility of mesh contamination. Two more trocars were added under direct vision respecting the peritoneal flap to perform an oncological sigmoidectomy. Surgical specimen was removed through the minimally enlarged transrectal incision of the left flank trocar, avoiding a Pfannenstiel incision that affected the previously repaired area. The patient was discharged 3 days after surgery and no complications or recurrence were reported 1 year after the procedure. In conclusion, the minimally invasive simultaneous approach of both complex procedures is safe and has a beneficial impact on patient’s morbidity and satisfaction, avoiding two separate surgical procedures and the risk of hernia complications between them.