title: Giant inguinal hernia: the challenging hug technique.
abstract: OBJECTIVE
  Giant inguinoscrotal hernia are a real challenge for every kind of surgeon. The technique that we adopt is suggested as a good option to deal with this cases. We report our experience in five cases of giant inguinoscrotal hernia with loss of domain from 2005 to 2012.
  
  
  METHODS
  Five patients with hernia that descended below the knees in the standing position, with an anteroposterior diameter not inferior to 30 cm and a laterolateral diameter of about 50 cm. Penis was not visible. We did the same procedure for all the five patients: single pararectus incision extended to groin region until proximal half of scrotum, isolation of the entire large sac out of the scrotal cavity, paying attention to not opening it, progressive reduction of the viscera without opening the sac with the hug technique, as shown in the video, placement of a heavyweight polypropylene meshes in the preperitoneal space, scrotal skin reductive plastic. In three of our five cases we obtained restoration of herniated viscera without resection of them. Orchiectomy was performed in all cases.
  
  
  RESULTS
  No general neither wound complications were recorded. Long term follow up ranges from 8 years to 18 months: we did not record recurrence or chronic groin pain and scrotal size is normal in each patient.
  
  
  CONCLUSIONS
  The technique proposed permits to treat with success giant inguinaoscrotal hernia, avoiding the use of further specific procedure such as the preoperative progressive pneumoperitoneum. All our patients were satisfied with the surgeries and their quality of daily life had definitely improved.
authors.affiliation: Basic and Applied Biomedical Sciences, University of Catania, Catania, Italy.|General and Day Surgery Unit, Center of Research and High Specialization for the Pathologies of Abdominal Wall and Surgical Treatment and Repair of Abdominal Hernia, Istituto Clinico Sant'Ambrogio, Via Faravelli 16, 20149, Milan, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Cavalli
authors.affiliation: University of Catania, Catania, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Biondi
authors.affiliation: General and Day Surgery Unit, Center of Research and High Specialization for the Pathologies of Abdominal Wall and Surgical Treatment and Repair of Abdominal Hernia, Istituto Clinico Sant'Ambrogio, Via Faravelli 16, 20149, Milan, Italy.
authors.forename: P G
authors.initials: PG
authors.lastname: Bruni
authors.affiliation: General and Day Surgery Unit, Center of Research and High Specialization for the Pathologies of Abdominal Wall and Surgical Treatment and Repair of Abdominal Hernia, Istituto Clinico Sant'Ambrogio, Via Faravelli 16, 20149, Milan, Italy. giampiero.campanelli@uninsubria.it.|University of Insubria, Varese, Italy. giampiero.campanelli@uninsubria.it.
authors.forename: G
authors.initials: G
authors.lastname: Campanelli
mesh_terms: D000328:Adult; D000368:Aged; D006552:Hernia, Inguinal / Q000473:pathology* / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009919:Orchiectomy; D011126:Polypropylenes; D012008:Recurrence; D013526:Surgical Mesh
chemical_list: D011126:Polypropylenes
keywords: Giant inguinoscrotal hernia; Hug technique; Loss of domain; Preoperative progressive pneumoperitoneum