Giant inguinoscrotal hernia repair with anterior component separation: a case report

INTRODUCTION: Giant inguinoscrotal hernias (GIH), defined as hernias extending below the midpoint of the inner thigh, are rare in developed countries. Loss of domain, the risk of abdominal compartment syndrome, and the absence of standardised guidelines make surgical management particularly complex. We present a case of GIH managed with single-stage repair and complex abdominal wall reconstruction, alongside a literature review of surgical strategies. CASE HISTORY: A 55-year-old bed-bound man presented with a progressively enlarging left scrotal swelling over 5 years. Computed tomography demonstrated a giant left inguinoscrotal hernia measuring 53cm craniocaudally with 72% loss of domain, containing the majority of the small and large bowel. He underwent elective single-stage repair via midline laparotomy comprising reduction of hernia contents, omentectomy, left orchidectomy, partial scrotal excision, bilateral anterior component separation and abdominal wall reconstruction using Strattice biologic mesh underlay with Prolene mesh onlay reinforcement. The patient recovered without significant complications with no evidence of recurrence at 15 months. FINDINGS: A structured literature review identified 15 published cases of GIH repair with abdominal wall reconstruction. Surgical approaches were categorised into four groups: debulking or resection of abdominal contents, techniques to increase abdominal cavity volume, combination strategies and use of adjuncts such as botulinum toxin. CONCLUSIONS: There remains no consensus on the optimal surgical management of GIH. This case supports anterior component separation as an effective single-stage strategy for GIH with significant loss of domain. In the absence of a standardised technique, a multidisciplinary approach is essential for optimising outcomes.