Laparoscopic Management of Inguinal Canal Fat Mass (Cord Lipoma) in Inguinal Hernia.

Background and objectives: Patients with an inguinal hernia usually report an inguinal bulge and pain. Inguinal canal fat can cause lower abdominal pain, swelling, and an inguinal hernia. Round ligament lipomas (RLLs) and inguinal cord lipomas (CLs) comprise invagination of extraperitoneal fat in the inguinal canal through the deep inguinal ring, with or without a hernia sac. During open surgery, The Inguinal canal fat mass (ICFM) previously labeled CL or RLL is usually excised and considered a CL, RLL, or inguinal canal lipoma. A lipoma is a benign tumor; therefore, it is not optimal to label inguinal fat as a lipoma. Moreover, lipoma incidence is 1 in 1,000; however, CL incidence is as high as 72.1%. During laparoscopy, it is difficult to observe the inguinal canal. CLs and RLLs can be missed during transabdominal preperitoneal and total extraperitoneal repair. We evaluated the importance of the anatomical identification and management of ICFM, previously labeled CL or RLL in laparoscopic inguinal hernia repair.

Methods: All patients (n = 102; 93 male and 9 female patients) with an inguinal hernia who underwent laparoscopic examination and management of the ICFM, previously labeled CL or RLL between May 2016 and May 2022 were included. All fatty mass of the inguinal were excised preserving the fat around the spermatic cord or round ligament.

Results: More inguinal fat was observed in female patients. After surgery, the patients' symptoms improved dramatically.

Conclusion: Laparoscopic retromuscular repair and exploration of the inguinal canal and excision of ICFM, previously labeled CL or RLL are less likely to result in missed inguinal hernias and more likely to result in good outcomes and fewer postoperative complications.