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Abstract Aims Surgery for inguinal hernias is one of the most performed surgical procedures around the world. A special sub-group of patients are those who have large inguinal hernias or inguinoscrotal hernias (ISH). They pose a challenge to surgeons with consistently higher rates of postoperative complications and recurrence when compared to “normal” inguinal hernias. Generally, recommendation for ISH hernias has been to attempt to completely reduce the hernia sac. The abandonment or transection of the hernia sac has been reserved only for cases in which the complete dissection is more difficult, takes a long time or some complications such as bleeding (non-planned tactic). Recently, this approach has been questioned due to the risk of complications and the planned abandonment of the hernia sac has been recommended by some authors. Methods Video-case presentation. Results A 62-year-old male patient presented with a large right inguinoscrotal hernia that had been increasing in size and causing discomfort, so we decided to perform surgical treatment using a laparoscopic TAPP approach, leaving the sac abandoned. 3 trocars are used to perform the surgery (1 × 12 mm and 2 × 5 mm). After visualizing the large size of the hernial sac, we decided to make the abandoned sac. The first step is to perform a transection of the peritoneum at the level of the deep inguinal ring in such a way that the hernia sac is disconnected from the rest of the peritoneum that we will dissect to place the mesh. The following steps are similar to those we usually perform in a laparoscopic TAPP inguinal hernia. We perform the peritoneal opening approx. 3–4 cm above the inguinal ring, we dissect the Retzius and Bogros space, we dissect the elements of the inguinal cord (this being easier when the hernial sac is left abandoned) and after completing a correct preperitoneal dissection we place a mesh 12 × 16 cm PPL. Finally, the peritoneal flap and the peritoneal defect in the inguinal ring area are closed. The patient presented a satisfactory evolution without complications and was discharged in 1°POD. The patient had a scrotal seroma that resolved during the 2°POM. Currently, after 18 months of follow-up, he has no signs of hernia recurrence. Conclusion Inguino-scrotal hernias represent a greater challenge for surgeons and are associated with a higher risk of recurrence and complications, mainly due to the difficulty in dissecting the hernia sac. Planned abandon of the hernia sac appears to be an interesting alternative in these cases, not only because it reduces the technical difficulty of the surgery but mainly because it is associated with a low rate of complications and acceptable seroma formation.
Trujillo et al. (Wed,) studied this question.