Laparoscopic Removal of a Large Spermatic Cord Lipoma During Bilateral Transabdominal Preperitoneal Inguinal Hernia Repair: A Case Report and Narrative Review of the Literature

Surgeons should be mindful of spermatic cord lipomas (or round ligament lipomas in women), as their presence may be overlooked during inguinal hernia repairs, leading to early pseudo-recurrence. These tumors can occur alongside an indirect hernia sac or on their own. Lipomatous lesions of the inguinal canal may occur as spermatic cord lipomas in men or round ligament lipomas in women. The incidence of these tumors varies, but they are more common in men. However, the estimated prevalence of these tumors that are not associated with an indirect hernia sac is quite low. It is important to note that these lesions are not true lipomas; rather, they originate from pre-peritoneal fat, travel through the inguinal canal, and may reach the testicles via the superficial inguinal ring. There is no consensus in the literature regarding the size threshold that categorizes these tumors as "large" or "giant." Clinically, preoperative diagnosis may be difficult, although spermatic cord lipoma can sometimes be suspected on physical examination, as they often present with symptoms similar to those of inguinal hernias. One useful method for identifying spermatic cord lipomas preoperatively is ultrasonography. Any discrepancy between preoperative findings and intraoperative observations should raise suspicion about the potential presence of a spermatic cord lipoma. All identified lipomas should either be excised or at least reduced, unless their presence obstructs the placement of the preperitoneal mesh. In this case, a 47-year-old male underwent a laparoscopic bilateral inguinal hernia repair using the transabdominal preperitoneal (TAPP) method. During the dissection of the left indirect inguinal hernia sac, a lipomatous mass measuring 10 x 5 cm was discovered, originating from the preperitoneal fat, and was subsequently excised. This report summarizes the available data on spermatic cord lipomas.