Missed Inguinal Cord Lipoma May Mimic Recurrence Following Endoscopic Repair of Groin Hernias

Abstract

To investigate the preoperative diagnosis, incidence rate, operation method, and recurrence as a cause of inguinal cord lipomas (ICL) in patients that were treated surgically due to groin hernia. This was a retrospective review of hernia repairs from January 2015 to January 2017 with open and endoscopic technique. Operative notes, pathologic reports, and demographic findings were evaluated in those patients. The same group of general surgeons performed all the procedures. A total of 722 patients were operated with the diagnosis of groin hernia. The patients were classified in two groups according to whether or not evaluation with the preoperative ultrasound (US). In total, 519 patients in group 1 had a preoperative US and underwent open surgery, whereas 203 patients in group 2 underwent endoscopic hernia surgery without a preoperative US examination. An US was performed before re-operation in recurrent cases. In group 1, 29 of 519 patients were identified as having ICL preoperatively through US with an incidence of 5.5%. Pathologic reports were confirmed as ICL in all of them. Six recurrences were seen in group 1 (1.15%) over at least 12 months follow-up period (12-48 months). ICL was not seen in these recurrences. Etiology of recurrence was mesh shrinkage in 5 and mesh migration in 1 patient. In group 2, 203 endoscopic hernia repairs were performed without a preoperative US. During the follow-up, 4 recurrences were diagnosed (1.9%). Although there was no suspicion of ICL left reported during the surgery from the operation notes, ICL was mimicking recurrence in two (0.9%) of them. Etiology of recurrence in the other 2 was mesh migration due to inadequate fixation. ICL could mimic recurrence if not removed or missed during hernia surgery. Preoperative US is a simple, useful, noninvasive, and cheap method in finding the ICL and preventing the re-operations.