Management of giant inguinal hernia; report of four cases and review of literature.

Abstract

<h4>Introduction</h4>Giant inguinal hernias are rare and their management is associated with peculiar challenges. Most publications are case reports and case series with few patients. This study aims to describe our experience in the management of four giant inguinal hernias and to review the literature with emphasis on the global distribution, presentation and approach to management. Researches on rare presentations are commonly challenging because of paucity of data.<h4>Case presentation</h4>We present four (4) cases of Giant inguinal hernia with ages between 39 years and 62 years with duration of groin swelling between 3 years and 32 years. Two had Type 1 Giant hernia while the others had Types 2 and 3. One was diabetic and hypertensive and another hypertensive. They both required multi-disciplinary management. All 3years and 32 yewere operated with oblique groin incisions. Polypropylene MESH was applied after simple closure of resultant wide defects in the posterior wall of the inguinal canal. Epidural anesthesia was used for three patients. The patient with Type 3 Giant hernia was done with General anesthesia. He required a debulking omentectomy and also needed respiratory support post-operatively. A literature review of patients in 10 years period with emphasis on the global distribution of publications, the presentation and the different approaches to management of patients was done.<h4>Conclusion</h4>Giant inguinal hernias though rare are encountered in all continents. Most are due to neglect and can be managed with a modified groin approach and Liechtenstein MESH hernioplasty. Multi-disciplinary approach to management with attention to possible complications due to size of the sac and co-morbidities are important. Studies are needed to guide and streamline management.