--- title: "Case Report: Massive Scrotal Hernia" description: Do you want to see how fasciotens is applied in a surgery? Read the case report for a detailed step-by-step and hear the surgeon's opinion --- [Go Back Up](https://www.fasciotens.com/case-report-massive-scrotal-hernia#top) [Skip to Content](https://www.fasciotens.com/case-report-massive-scrotal-hernia#body) [![fasciotens home](https://www.fasciotens.com/hs-fs/hubfs/Logos/fasciotens_logo_aws_2020.png?width=200&height=52&name=fasciotens_logo_aws_2020.png "fasciotens home")](https://www.fasciotens.com?hsLang=en) Toggle Menu - [Open Abdomen](https://www.fasciotens.com/abdomen) Toggle children for Open Abdomen Main Menu (Press to Return) > Open Abdomen - [Discover more](https://www.fasciotens.com/abdomen) - [Publications & Case Reports](https://www.fasciotens.com/case-reports-abdomen) - [E-learning courses](https://academy.fasciotens.com/pages/abdomen) - [How-tos & Instructions](https://www.fasciotens.com/how-tos-abdomen) - [Complex Hernias](https://www.fasciotens.com/hernia) Toggle children for Complex Hernias Main Menu (Press to Return) > Complex Hernias - [Discover more](https://www.fasciotens.com/hernia) - [Publications & Case Reports](https://www.fasciotens.com/case-reports-hernia) - [E-learning courses](https://academy.fasciotens.com/collections/hernia) - [How-tos & Instructions](https://www.fasciotens.com/how-tos-hernia) - [Congenital Defects](https://www.fasciotens.com/pediatric) Toggle children for Congenital Defects Main Menu (Press to Return) > Congenital Defects - [Discover more](https://www.fasciotens.com/pediatric) - [How-tos & Instructions](https://www.fasciotens.com/how-tos-pediatric) - [Congresses & Workshops](https://www.fasciotens.com/congresses-workshops) - Services Toggle children for Services Main Menu (Press to Return) > Services - [E-Learning](https://academy.fasciotens.com) - [Case Discussion](https://www.fasciotens.com/case-discussion) - [Product Feedback & Complaints](https://www.fasciotens.com/product-feedback) - [Downloads](https://www.fasciotens.com/downloads) - [Newsletter](https://www.fasciotens.com/newsletter) - [About us](https://www.fasciotens.com/about-us) - [Local Distribution Partners](https://www.fasciotens.com/contact#distributor) - [Contact](https://www.fasciotens.com/contact) - - [English](https://www.fasciotens.com/case-report-massive-scrotal-hernia) - [Deutsch](https://www.fasciotens.com/de/case-report-massive-scrotal-hernia) ![Giant scrotal hernia_Title](https://www.fasciotens.com/hs-fs/hubfs/Case%20Reports/Hernia_2023_11_DE_Laparoscopic/Giant%20scrotal%20hernia_Title.jpg?width=1024&height=1024&name=Giant%20scrotal%20hernia_Title.jpg) Monstrous scrotal hernia # Laparoscopic application to enable Lichtenstein Repair *Augusta Hospital, Bochum, Germany - November 2023* Metin Mazgaldzhi and Benno Mann treated this patient with a massive inguinal hernia. Nearly all of the intestines had migrated into the hernia sac. They used fasciotens® to increase the intra-abdominal volume to allow a repositioning of the intestines inside the abdominal cavity without risking an abdominal compartment syndrome. ![Giant scrotal hernia_before](https://www.fasciotens.com/hs-fs/hubfs/Case%20Reports/Hernia_2023_11_DE_Laparoscopic/Giant%20scrotal%20hernia_before.jpg?width=1024&height=1024&name=Giant%20scrotal%20hernia_before.jpg) ### Increasing intra-abdominal volume To make sure that relocating the organs to their original location in the abdominal cavity would not lead to a rise of the intra-abdominal pressure (IAP), the surgeons decided pre-operatively to increase the intra-abdominal volume by using Intraoperative Fascial Traction (IFT). ![Giant scrotal hernia_Botox](https://www.fasciotens.com/hs-fs/hubfs/Case%20Reports/Hernia_2023_11_DE_Laparoscopic/Giant%20scrotal%20hernia_Botox.jpg?width=1024&height=1024&name=Giant%20scrotal%20hernia_Botox.jpg) ### Pre-treatment with botulinum toxin A (BTA) The patient received BTA injections 3 weeks before the hernia repair. The desired result was achieved, having a relaxation of the lateral abdominal wall. BTA aligns very well with IFT, especially in Loss of Domain defects. ![Giant scrotal hernia_Anaesthesia](https://www.fasciotens.com/hs-fs/hubfs/Case%20Reports/Hernia_2023_11_DE_Laparoscopic/Giant%20scrotal%20hernia_Anaesthesia.jpg?width=1024&height=1024&name=Giant%20scrotal%20hernia_Anaesthesia.jpg) ### Full relaxation during anaesthesia The patient was kept under general anaesthesia with muscle relaxant on a drip (perfusor). Complete muscle relaxation during IFT is an important step to achieve the greatest possible stretching of the abdominal wall during the treatment.  ![Giant scrotal hernia_laparoscopic application](https://www.fasciotens.com/hs-fs/hubfs/Case%20Reports/Hernia_2023_11_DE_Laparoscopic/Giant%20scrotal%20hernia_laparoscopic%20application.jpg?width=1024&height=1024&name=Giant%20scrotal%20hernia_laparoscopic%20application.jpg) ### Laparoscopical application of fasciotens Since the patient presented with an inguinal hernia, the abdominal wall and midline were fully intact. To minimize the impact on these structures, the procedure was performed laparoscopically. The Lichtenstein technique was employed following standard open surgical protocol. ![Giant scrotal hernia_U Suture](https://www.fasciotens.com/hs-fs/hubfs/Case%20Reports/Hernia_2023_11_DE_Laparoscopic/Giant%20scrotal%20hernia_U%20Suture.jpg?width=1024&height=1024&name=Giant%20scrotal%20hernia_U%20Suture.jpg) ### Attaching the traction sutures to the fascia The braided suture threads (USP 2) are stitched as U-sutures to the fascia. For the maximum effect, the threads should be stitched into the linea alba. ![Giant scrotal hernia_Distribution Suture Threads](https://www.fasciotens.com/hs-fs/hubfs/Case%20Reports/Hernia_2023_11_DE_Laparoscopic/Giant%20scrotal%20hernia_Distribution%20Suture%20Threads.jpg?width=1024&height=1024&name=Giant%20scrotal%20hernia_Distribution%20Suture%20Threads.jpg) ### Evenly distribution along the fascia Usually, six suture threads are used per side. In this case, Metin used only five threads per side because access to the midline was limited caudally due to the massive inguinal hernia. ![Giant scrotal hernia_Repairing hernia](https://www.fasciotens.com/hs-fs/hubfs/Case%20Reports/Hernia_2023_11_DE_Laparoscopic/Giant%20scrotal%20hernia_Repairing%20hernia.jpg?width=1024&height=1024&name=Giant%20scrotal%20hernia_Repairing%20hernia.jpg) ### Repairing the hernia  While stretching the lateral abdominal wall to increase the intra-abdominal volume was carried out, inguinal hernia repair was done simultaneously. ![Giant scrotal hernia_Re-tightening the suture threads](https://www.fasciotens.com/hs-fs/hubfs/Case%20Reports/Hernia_2023_11_DE_Laparoscopic/Giant%20scrotal%20hernia_Re-tightening%20the%20suture%20threads.jpg?width=1024&height=1024&name=Giant%20scrotal%20hernia_Re-tightening%20the%20suture%20threads.jpg) ### Re-tightening the suture threads While Benno Mann was working on the hernia, Metin made sure to re-tighten the traction sutures every 2 minutes. Since the fascia is not a homogenous structure, some areas stretch faster than others. Therefore Metin checked each suture individually and pulled them tight again if necessary. You can use the hand wheel to increase the traction force on all threads at once. ![Giant scrotal hernia_Adhesiolysis](https://www.fasciotens.com/hs-fs/hubfs/Case%20Reports/Hernia_2023_11_DE_Laparoscopic/Giant%20scrotal%20hernia_Adhesiolysis.jpg?width=1024&height=1024&name=Giant%20scrotal%20hernia_Adhesiolysis.jpg) ### Adhesiolysis The patient had severe adhesions, attributed to the prolonged existence of the hernia, which surgeons presumed to be congenital and to have developed over the course of the last 50 years. ![Giant scrotal hernia_Relocating the organs](https://www.fasciotens.com/hs-fs/hubfs/Case%20Reports/Hernia_2023_11_DE_Laparoscopic/Giant%20scrotal%20hernia_Relocating%20the%20organs.jpg?width=1024&height=1024&name=Giant%20scrotal%20hernia_Relocating%20the%20organs.jpg) ### Relocating the organs Even though the hernia gap itself was rather small and the loss of domain was massive, the surgeons could maneuver the intestines back into the abdominal cavity surprisingly smoothly. ![Giant scrotal hernia_Combination open_laparoscopic](https://www.fasciotens.com/hs-fs/hubfs/Case%20Reports/Hernia_2023_11_DE_Laparoscopic/Giant%20scrotal%20hernia_Combination%20open_laparoscopic.jpg?width=1024&height=1024&name=Giant%20scrotal%20hernia_Combination%20open_laparoscopic.jpg) ### Keeping the device attached during reconstruction While Lichtenstein repair was performed the surgeons kept the device in place to allow an continued stretching of the abdominal wall to maximize the increase in abdominal volume. ![Giant scrotal hernia_Removal Skin](https://www.fasciotens.com/hs-fs/hubfs/Case%20Reports/Hernia_2023_11_DE_Laparoscopic/Giant%20scrotal%20hernia_Removal%20Skin.jpg?width=1024&height=1024&name=Giant%20scrotal%20hernia_Removal%20Skin.jpg) ### Removal of massive skin excess The huge hernia sac, skin & tissue measured up to 7 kg. It was removed without any complications. ![Giant scrotal hernia_Disassembly](https://www.fasciotens.com/hs-fs/hubfs/Case%20Reports/Hernia_2023_11_DE_Laparoscopic/Giant%20scrotal%20hernia_Disassembly.jpg?width=1024&height=1024&name=Giant%20scrotal%20hernia_Disassembly.jpg) ### Disassembly of the fasciotens device To allow better access to the wound area, the device was easily disassembled while Benno was performing the wound closure. ![Giant scrotal hernia_Removing Suture Threds](https://www.fasciotens.com/hs-fs/hubfs/Case%20Reports/Hernia_2023_11_DE_Laparoscopic/Giant%20scrotal%20hernia_Removing%20Suture%20Threds.jpg?width=1024&height=1024&name=Giant%20scrotal%20hernia_Removing%20Suture%20Threds.jpg) ### Removing the traction sutures The traction sutures can be taken out easily without the laparoscopic tools. Simply pull on one end carefully until the suture thread comes out completely. ![Giant scrotal hernia_Result](https://www.fasciotens.com/hs-fs/hubfs/Case%20Reports/Hernia_2023_11_DE_Laparoscopic/Giant%20scrotal%20hernia_Result.jpg?width=1024&height=1024&name=Giant%20scrotal%20hernia_Result.jpg) ### Result The successful repair of the massive scrotal hernia significantly increased the Quality of Life of the patient. He felt well and was back to a normal life 3 weeks after the surgery. ![Cover_Hernia_DE_Bochum_Metin Mazgaldzhi](https://www.fasciotens.com/hs-fs/hubfs/Case%20Reports/Hernia_2023_11_DE_Laparoscopic/Cover_Hernia_DE_Bochum_Metin%20Mazgaldzhi.jpg?width=1920&height=1080&name=Cover_Hernia_DE_Bochum_Metin%20Mazgaldzhi.jpg) × ### Metin Mazgaldzhi was pleased with the effectiveness of the laparoscopic IFT This was the most complex hernia the leading surgeon had ever seen in his hospital. That given, Metin was even more impressed with how well the intraoperative fascial traction worked using fasciotens®Hernia. Start with fasciotens yourself ### Do you want to use fasciotens®Hernia during your next complex hernia surgery? Fill out the form and we will get in touch asap. [![fasciotens home](https://www.fasciotens.com/hs-fs/hubfs/Logos/fasciotens_logo_aws_2020.png?width=200&height=52&name=fasciotens_logo_aws_2020.png "fasciotens home")](https://fasciotens.com?hsLang=en) - [About us](https://www.fasciotens.com/about-us) - [Contact](https://www.fasciotens.com/contact) - [Privacy](https://www.fasciotens.com/privacy) - [Terms & conditions](https://www.fasciotens.com/terms-conditions) - [Imprint](https://www.fasciotens.com/imprint) [tel:+4920199999630](tel:+4920199999630) [mailto:info@fasciotens.de](mailto:info@fasciotens.de)