title: Modified technique of laparoscopic intraperitoneal hernioplasty for irreducible scrotal hernias (omentoceles): how to remove the hernial contents.
abstract: BACKGROUND
  The surgical repair of large irreducible scrotal hernias is, in general, technically difficult. Laparoscopic repair for these cases is controversial, although extraperitoneal and transperitoneal approaches have been described. We present a small series of patients with large irreducible groin hernias (omentoceles) treated by laparoscopy and a modification to facilitate complete removal of the omentum from the sac.
  
  
  METHODS
  We prefer laparoscopic transperitoneal repair for large irreducible scrotal hernias, with as much omentum as possible being excised. Then a small groin incision is made to excise the remaining omentum.
  
  
  RESULTS
  All of the patients in this study were male, and their average age was 66 years (60-72 years). Eight patients presented with seromas at the first follow-up; three required repeated aspiration, and the rest resolved spontaneously. There were no cases of wound or mesh infection/migration or recurrence after a follow-up of 36 months.
  
  
  CONCLUSIONS
  At the beginning of our experience, if these hernias could not be reduced, we converted to the open procedure. Now, using the modification with which we remove the adherent omentum from the distal sac, there are no conversions. This technique could make life easier for laparoscopic surgeons who attempt repair of large irreducible scrotal hernias, a not uncommon occurrence in developing countries.
authors.affiliation: GEM Hospital, 45-A Pankaja Mill Road, Ramnathapuram, Coimbatore, 641045, India.
authors.forename: Chinnusamy
authors.initials: C
authors.lastname: Palanivelu
authors.affiliation: GEM Hospital, 45-A Pankaja Mill Road, Ramnathapuram, Coimbatore, 641045, India. rangy68@gmail.com.
authors.forename: Muthukumaran
authors.initials: M
authors.lastname: Rangarajan
authors.affiliation: GEM Hospital, 45-A Pankaja Mill Road, Ramnathapuram, Coimbatore, 641045, India.
authors.forename: Suviraj James
authors.initials: SJ
authors.lastname: John
mesh_terms: D000368:Aged; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009852:Omentum / Q000601:surgery; D010537:Peritoneum / Q000601:surgery*; D013526:Surgical Mesh; D013997:Time Factors; D016896:Treatment Outcome