Intraoperative handling of spermatic cord lipomas during inguinal hernia repair: a nationwide survey

Abstract

Purpose: Cord lipomas can clinically resemble groin hernias and missed cord lipomas can potentially result in persistent symptoms. However, no international guideline exists concerning the management of cord lipomas found during inguinal hernia surgery. This study aimed to gain insight into how surgeons typically manage cord lipomas found during inguinal hernia surgery.

Methods: A questionnaire was sent to all general surgeons in Denmark performing unsupervised laparoscopic inguinal hernia repair and Lichtenstein repair. The survey contained questions about demographic details and questions about how surgeons would handle cord lipomas. The questionnaire was created by the research team and face-validated on general surgeons.

Results: A total of 58 surgeons (60%) responded to the questionnaire. The majority agreed that cord lipomas should not be left untouched. During laparoscopic repairs, 53% of the surgeons recommended that cord lipomas should be resected and removed if the anatomical circumstances allowed it. During Lichtenstein repair, the surgeons recommended that cord lipomas should always be resected and removed (49%) or that resection should depend on the size of the lipoma (44%).

Conclusion: When asking surgeons about their preferred handling of cord lipomas, they answered that the management of cord lipomas found during inguinal hernia surgery depends on anatomical circumstances such as the pedicle appearance, the lipoma mobility, and its size. If the cord lipoma is left untouched, the patients' hernia resembling symptoms could persist, why the surgeons predominantly preferred to resect and remove cord lipomas.

Keywords: Inguinal hernia repair; Laparoscopic repair; Lichtenstein repair; Questionnaire; Spermatic cord lipoma; Survey.