Giant inguinoscrotal hernias might be considered as negligible. However, they still occur, even in developed countries, and then present a challenging surgical problem. Defined as the extension below the midpoint of the inner thigh in the standing position,
1 giant inguinoscrotal hernias still vary widely in their size and appearance. Depending on the comorbidities of the patients, different surgical approaches have been reported. They are all sharing the same strategy of relocating the organs into the abdominal cavity that have lost their “right of domain” without increasing the abdominal pressure excessively and thus reducing the venous return or a compromising of the pulmonary or cardiac function. In the past, two general principles have been advocated. On the one hand, the abdominal space is increased by (1) progressive pneumoperitoneum,
2,
3 (2) abdominal wall separation,
4 or (3) combined mesh and flap techniques (including mesh repair to create an abdominal wall defect for increasing the intra-abdominal capacity).
5,
6 On the other hand, abdominal organs are resected to reduce the size of organs that need to be relocated.
7 Endoscopic techniques have been reported but should be assessed very critically.
8 The enlargement of the abdomen by pneumoperitoneum, in general, showed to be a valid method. However, in very large giant hernias, it failed several times.
9,
10 In situations of infected hernia sac, pneumoperitoneum should be avoided,
11,
12 and a stepwise procedure has previously been suggested.
13 In these special situations, nonabsorbable meshes should be avoided due to their potential infection.
14
Orchiectomy of non-necrotic testis is still controversy discussed as chances of testicular torsion or infection, or even recurrence is increased if left in place.
15 With regard to the resection of the hernial sac, the development of scrotal hematoma and/or massive lymphedema is possible.
9 Otherwise, redundant scrotal skin has the possibility to save as a safety net in case of recurrence of increased intra-abdominal pressure.
10