Is there a role for botulinum toxin in inguinal hernia surgery? Case report on the management of a giant scrotal hernia

Summary The use of botulinum toxin A in the management of ventral hernias is a well-established method to potentially spare the patient a surgical component operation or a visceral resection during the repair of loss-of-domain hernias with the goal of reducing the intra-abdominal pressure and avoiding complications like ischemia as result of decreased organ perfusion. For very large inguinal hernias, this approach has not yet gained general acceptance as a treatment option. Standard procedures for inguinal hernia repair to date include Lichtenstein, TAPP/TEPP, or Shouldice procedures. Preconditioning of the abdominal wall with botulinum toxin is not currently part of the standard procedure for the management of inguinal hernias, since these are less frequently associated with loss of domain and, therefore, rarely demand surgical component separation or visceral resection for the reduction of herniated organs. We discuss the case of a 73-year-old patient who was presented to the clinic with a bilateral inguinal hernia. Since the left-sided hernia was a massive scrotal hernia with loss of domain, a staged approach to the repair was planned. We discuss the findings, management, and outcome of the treatment.