Large scrotal hernias: Totally extraperitoneal (TEP) or transabdominal preperitoneal (TAPP) repair?

Abstract

INTRODUCTION: Large scrotal hernias are rare, constituting <2% of all hernias repairs. Few of these large scrotal hernias become massive or giant due to neglect in treatment for many years. Conventionally, open surgery was advocated for these hernias, but with experience, laparoscopic repairs have been performed in the recent years for these hernias. PATIENTS AND METHODS: We reviewed our experience of patients with large scrotal hernias (L3, M3, or R) undergoing either totally extraperitoneal (TEP) or transabdominal preperitoneal (TAPP). Demographic profile, clinical characteristics of hernia, and intra- and postoperative outcomes were recorded. RESULTS: There were 144 patients with large hernias, of which 10 were massive hernias. TEP repair was attempted in 85 patients and TAPP repair in 59 patients. In 25 patients (7 in TEP and 18 in TAPP), laparoscopic-assisted approach was used. TEP repair successful in 64 patients (75.3%) and converted to TAPP in 15 patients (17.6%) and to open in 6 patients (7.1%). TAPP was successful in 53 patients (89.8%) and was converted to open repair in 6 patients (10.2%). Seroma was noted in 42 patients, spermatic cord edema in 26 patients, and scrotal hematoma in 14 patients at 1st week. The mean follow-up was 2 years. Two patients had recurrence and TAPP repair was done. None of the patients developed mesh infection or chronic groin pain. CONCLUSION: We believe that TEP and TAPP repair are complementary and hernia surgeons should be adept at both techniques. TAPP repair has advantages in large irreducible hernias and should be preferred.

Keywords

• hybrid
• large scrotal hernia
• massive
• totally extraperitoneal
• transabdominal preperitoneal