Technical Refinements in Laparoscopic Transabdominal Preperitoneal Repair for Scrotal Hernia Using High Sac Transection and Internal Ring Closure.

Abstract

Inguinoscrotal hernia is a challenging subtype of inguinal hernia due to its large hernia sac, scrotal extension, and increased risk of postoperative complications, including seroma formation and recurrence. Although laparoscopic transabdominal preperitoneal (TAPP) repair is widely accepted for inguinal hernia management, optimal strategies for hernia sac handling and internal ring reconstruction in scrotal hernias remain controversial. We report the case of a 54-year-old man with a right inguinoscrotal hernia who underwent laparoscopic TAPP repair incorporating high transection of the hernia sac combined with internal ring closure. The procedure was completed successfully without intraoperative complications. The postoperative course was uneventful, and no recurrence, chronic pain, or scrotal seroma was observed during nine months of follow-up. This case suggests that high sac transection combined with anatomical narrowing of the internal ring may simplify the surgical procedure, reduce tissue trauma, and enhance repair stability in selected patients with inguinoscrotal hernia.