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Abdominoscrotal Hydrocele - Considerations.

J Indian Assoc Pediatr Surg

July 2024

Department of Paediatric Surgery, Childs Trust Medical Research Foundation, Kanchi Kamakoti Childs Trust Hospital, Chennai, Tamil Nadu, India.

Aim: The aim of the study was to highlight the pathology, clinical spectrum, and approach considerations in abdominoscrotal hydrocele (ASH).

Materials And Methods: Our study included eight children with ASH from 2015 to 2022. The demographics, clinical presentation, investigations, operative details, and postoperative outcome were collected retrospectively from case files.

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Article Synopsis
  • A giant inguinoscrotal hernia can extend below the midpoint of the thigh and is often due to patient neglect and fear of surgery.
  • Patients usually experience lower urinary tract symptoms and may develop ulcers from urine dribbling, with rare cases of obstruction or strangulation.
  • This case involved a successful laparoscopic repair of an uncomplicated giant inguinoscrotal hernia through preoperative optimization techniques, including BOTOX and progressive pneumoperitoneum, highlighting the importance of patient preparation for surgical interventions.
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Inguinoscrotal hernia (ISH) is an entity for which treatment is under debate. Open surgery is the standard approach, but the laparoscopic technique has a great outcome when used by experienced surgeons. Seroma is one of the complications following laparoscopic hernia repair for these scrotal hernias, which is due to the large hernia sac, usually transected, leaving in place a remnant of the sac.

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The advantages of enhanced view totally extraperitoneal (eTEP) over TEP approach are well established in large inguinoscrotal, recurrent inguinal, patients with short pubis to umbilicus distance and in obese patients. Irreducible inguinoscrotal hernias (IISHs) and giant inguinal hernias (GIHs) pose a great challenge. GIHs are hernias which extend below the midpoint of the inner thigh with the patient in the standing position.

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Although inguinal hernia repair is one of the most common surgical procedures, finding a retroperitoneal structure, such as the ureter, is a rather rare occurrence. Ureteroinguinal hernias may arise in the presence or absence of obstructive uropathy, the latter raising difficulties in diagnosis for the general surgeon performing a regular inguinal hernia surgery. This study aims to collect the relevant literature describing the diagnosis and management of ureteroinguinal hernias and update it with a case encountered in our clinic.

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