Giant Inguino-Scrotal Hernia With Loss of Domain: Surgical Report and Literature Review

The surgical repair of giant inguinal hernias with loss of domain, defined as the relocation of the majority of the intestine into the hernia sac, poses a significant challenge. In the majority of cases, a combination of different surgical techniques with the placement of multiple meshes is necessary to achieve reduction of such complex hernias. The reduction of chronic giant hernias can increase the risk of abdominal compartment syndrome or cardiopulmonary complications. This case study presents a rare and complex case of a patient with a chronic giant inguinal hernia, in which almost the entire intestine was herniated, involving the scrotum and reaching mid thigh. The reduction of the hernia was achieved by a combined open transabdominal and inguinal approach, utilizing the abdominal component separation technique and multiple preperitoneal mesh placements. This multimodal approach resulted in optimal outcomes in terms of cosmesis, functionality, and abdominal wall integrity.