Repair Of A Giant Inguinal Hernia
INTRODUCTION: A giant inguinal hernia is defined as a hernia that extends beyond the midpoint of the inner thigh when in a standing position. It is more uncommon than other inguinal hernias and is difficult to treat surgically.
CASE DESCRIPTION: A 76-year old gentleman presented with a giant right inguinal hernia. Over the last 20 years, the hernia had progressively increased in size and adversely affected his quality of life leading to: loss of the normal micturition mechanism requiring self-catheterization; back pain, postural change and perturbation to his stance with shifting the center of body mass due to progressively increasing weight of the scrotum; and mechanically-limited ambulation. On examination, the patient had a scaphoid abdomen with a giant, non-reducible right inguinoscrotal hernia extending down to the level of his knees. He was hospitalized for a small bowel obstruction within his hernia as seen on a CT scan and was managed non-operatively. After a pre-operative medical optimization, a partial omentectomy and mesh repair were performed. The patient was discharged home on POD#3. He developed early satiety that improved over two weeks. At five months follow-up, the patient is doing well with pain resolved. He is tolerating a general diet and has an improved quality of life.
CONCLUSIONS: Giant inguinal hernias are challenging to manage surgically. This case discusses a successful operation that has demonstrated a favorable outcome at five months following the repair.