Surgical treatment of the giant inguinal hernia

Summary The authors present 5 cases of giant inguinal hernias observed over a ten-year period (1987–1997) in 1000 patients undergoing inguinal hernia operations. Such hernial formations are rare today (only 5% of the cases) thanks to better hygienic conditions and better hernioplasty techniques, carried out with local anesthesia, that encourage patients to undergo an operation shortly after diagnosis. Of the 5 cases reported, all primary hernias, 4 were implanted with a dacron-mersilene lattice prosthesis by the Rives technique, while in one case the Shouldice technique was used. The problem the authors found in operating on these large hernial formations relates mainly to orchidectomy and whether or not to carry out a reductive plastic surgery of the scrotum after the operation. Orchidectomy, which was performed in all 5 patients, was often a necessity because of unusual length of the spermatic cord, atrophy of the testicle and also to allow the hernioplasty to be carried out more easily. Reductive plastic surgery of the scrotum, carried out in 2 of the 5 cases presented, becomes necessary when, due to inelasticity, there is no or insufficient retraction of the dartos muscle, thus leaving an abnormally huge scrotum that in time may turn into a form of elephantiasis due to lymphedema, and for which an unpleasant re-operation often needs to be carried out.