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. 2020 Nov 20;33(2):e1519.
doi: 10.1590/0102-672020200002e1519. eCollection 2020.

PRIMARY ABANDON-OF-THE-SAC (PAS) TECHNIQUE: PRELIMINARY RESULTS OF A NOVEL MINIMALLY INVASIVE APPROACH FOR INGUINOSCROTAL HERNIA REPAIR

[Article in English, Portuguese]
Alexander Charles Morrell  1   2   3 , Andre Luiz Gioia Morrell  1   2   3 , Flavio Malcher  4 , Allan Gioia Morrell  1   3 , Alexander Charles Morrell-Junior  1   3
Affiliations

PRIMARY ABANDON-OF-THE-SAC (PAS) TECHNIQUE: PRELIMINARY RESULTS OF A NOVEL MINIMALLY INVASIVE APPROACH FOR INGUINOSCROTAL HERNIA REPAIR

[Article in English, Portuguese]
Alexander Charles Morrell et al. Arq Bras Cir Dig. .

Abstract
in English, Portuguese

Background: Laparoscopic best approach of repairing inguinoscrotal hernias are still debatable. Incorrect handling of the distal sac can possibly result in damage to cord structures and negative postoperative outcomes as ischemic orquitis or inguinal neuralgia.

Aim: To describe a new technique for a minimally invasive approach to inguinoscrotal hernias and to analyze the preliminary results of patients undergoing the procedure.

Methods: A review of a prospectively maintained database was conducted in patients who underwent minimally invasive repair using the "primary abandon-of-the-sac" (PAS) technique for inguinoscrotal hernias. Patient´s demographics, as well as intraoperative variables and postoperative outcomes were also analyzed.

Results: Twenty-six male were submitted to this modified procedure. Mean age of the case series was 53.8 years (range 34-77) and body mass index was 26.8 kg/m2 (range 20.8-34.2). There were no intraoperative complications or conversion. Average length of stay was one day. No surgical site infections, pseudo hydrocele or neuralgia were reported after the procedure and two patients presented seroma. No inguinal hernia recurrence was verified during the mean 21.4 months of follow up.

Conclusion: The described technique is safe, feasible and reproducible, with good postoperative results.

Racional:: A melhor maneira laparoscópica do reparo de hérnias inguinoescrotais permanece ainda aberta a discussão. O manuseio incorreto do saco herniário pode resultar em danos às estruturas do cordão e resultados pós-operatórios indesejados, como orquite isquêmica ou neuralgia inguinal.

Objetivo:: Descrever uma nova técnica de abordagem minimamente invasiva das hérnias inguinoescrotais e analisar os resultados preliminares de pacientes submetidos ao procedimento.

Métodos:: Foi realizada na série de casos a análise retrospectiva de um banco de dados mantido prospectivamente em pacientes submetidos a reparo minimamente invasivo usando a técnica “abandono primário do saco” (PAS) para hérnias inguinoescrotais. Dados demográficos dos pacientes, bem como variáveis intraoperatórias e resultados pós-operatórios são descritos.

Resultados:: Vinte e seis homens foram submetidos ao procedimento. A idade média foi de 53,8 anos e o índice de massa corpórea de 26,8 kg/m2. Não houve complicações intraoperatórias ou conversão para operação aberta. A duração média da estadia hospitalar foi de um dia. Não foram relatadas infecções de sítio cirúrgico, hematomas ou neuralgia após o procedimento e a presença de seroma ocorreu em dois pacientes. Nenhuma recorrência de hérnia inguinal foi verificada durante média de 21,4 meses.

Conclusão:: A técnica descrita é segura e replicável, apresentando bons resultados pós-operatórios.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: none

Figures

FIGURE 1
FIGURE 1. Views of left inguinoscrotal hernia sac: A) external; B) laparoscopic
FIGURE 2
FIGURE 2. The “pirate-eye-patch” peritoneal flap dissection draft, with the primary abandon-of-the-sac approach
FIGURE 3
FIGURE 3. Peritoneal flap dissection bordering the hernia defect anterior and posteriorly, leaving both dissected planes in an ellipsoid or circular shape
FIGURE 4
FIGURE 4. Both medially and laterally extension of the peritoneal flap dissection: medial limit - medial umbilical ligament; lateral limit - approximating the anterosuperior iliac spine
FIGURE 5
FIGURE 5. A) View of the right myopectineal orifice after complete dissection, with the abandoned sac circled and anatomical landmarks enhanced; B) final view of the implanted mesh
None
Link to complementary video: https://youtu.be/FOlbF58L6ug
See this image and copyright information in PMC

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