Cord lipoma: how does it impacts on MIS inguinal hernia repairs.

Abstract

Introduction: Despite advances in understanding anatomy and steps for MIS inguinal hernia repair, controversies still remain. Spermatic cord lipoma (SCL), which is easily recognized in open repairs, has been neglected in MIS repairs. SCL has been considered the main cause of misdiagnosis of "hernia recurrence" after MIS.

Aim: Purpose of this study was to evaluate the incidence of SCL and the implications of its dissection on postoperative outcome.

Methods: Prospective cohort study of 200 consecutive patients who underwent MIS repairs between May 2022 and October 2023. Visual Analogue Scale (VAS) for pain and complications is evaluated.

Results: Three hundred and eleven hernias were repaired. SCL was found in 39% of patients and in 37.6% of hernia repairs. BMI was significantly associated with the probability of having SCL. The risk of patients with BMI >30 was 2.84 times higher than those with BMI <30. Gender or EHS hernia classification was not related to the incidence of SCL. Mean additional time to dissect the lipoma was 2.6 min, which represents only 4% of total time. Although VAS in the inguinal region was statistically higher (or showed statistical trend) in the postoperative evaluations comparing lipoma dissection versus no lipoma groups (0.5 vs. 0.2; 1.3 vs. 1.0; 0.3 vs. 0.1 on days 7 and 30 and at 6 months, respectively), from a clinical point of view, this difference can be considered not relevant (mean difference inferior than 0.5 points on VAS). For the testicular region, there was no difference in VAS between the groups. There was no difference regarding complications comparing the lipoma dissection group versus no lipoma.

Conclusion: Incidence of SCL is high in patients undergoing inguinal hernia repair, even higher in obese patients, and cannot be "missed" during the surgery. SCL dissection is simple and does not significantly increase operative time or cause perioperative surgical complications.