title: Surgical repair of giant inguinoscrotal hernias in an austere environment: leaving the distal sac limits early complications.
abstract: OBJECTIVE
  Giant inguinoscrotal hernias represent a real public health problem in the Ivory Coast that can dramatically impair patients' quality of life. Limited resources require a simplified surgical strategy including, in our experience, not using a mesh and leaving the distal hernia sac. The aim of this study was to evaluate the benefits of this technique in terms of complications (seroma, haematoma, trophic troubles) and the ability to recover from surgery and return to work at 1 month postsurgery.
  
  
  METHODS
  Between January and May 2012, all patients who presented with a giant primary inguinoscrotal hernia that was spontaneously reducible in the decubitus position and who did not have any trophic changes in the scrotal skin were prospectively studied. The surgical procedure was a herniorrhaphy as described by Bassini. All patients received follow-up examinations on postoperative days 5, 12 and 30.
  
  
  RESULTS
  Twenty-five males with a median age of 42 years (range 18-60) underwent surgery. Three patients (12 %) presented with a superficial skin infection and four (16 %) with early scrotal swelling without seroma, spontaneously resolved by postoperative day 30. Three patients (12 %) presented with scrotal swelling and seroma; two required aspiration. No early recurrence was observed at the end of follow-up, and all patients were able to return to work.
  
  
  CONCLUSIONS
  Leaving the distal hernial sac in the scrotum does not interfere with the type of hernia repair and can limit the occurrence of complications. This technique is reliable, reproducible and does not incur additional morbidity when used in selected patients.
authors.affiliation: Department of Urology, Sainte-Anne University Military Hospital, Toulon, France.
authors.forename: P-H
authors.initials: PH
authors.lastname: Savoie
authors.forename: S
authors.initials: S
authors.lastname: Abdalla
authors.forename: J
authors.initials: J
authors.lastname: Bordes
authors.forename: J
authors.initials: J
authors.lastname: Laroche
authors.forename: R
authors.initials: R
authors.lastname: Fournier
authors.forename: F
authors.initials: F
authors.lastname: Pons
authors.forename: S
authors.initials: S
authors.lastname: Bonnet
mesh_terms: D000293:Adolescent; D000328:Adult; D007560:Cote d'Ivoire; D003906:Developing Countries; D004487:Edema / Q000209:etiology; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D012611:Scrotum / Q000601:surgery*; D017192:Skin Diseases, Bacterial / Q000209:etiology*; D013530:Surgical Wound Infection / Q000209:etiology*; D055815:Young Adult