Spermatic Cord Lipoma Management During Laparoscopic Inguinal Hernia Surgery

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General Surgery

Case description

A presentation of two cases of A spermatic cord lipoma management during a laparoscopic inguinal hernia surgery.

The  incidence of cord lipoma associated with indirect inguinal hernia is of 70%  and the prevalence of single spermatic cord lipoma, meaning without an indirect hernia sachas a  incidence of 6.4%.

It is likely that the frequency may significantly increase depending on how actively we are looking for it.

A missed spermatic cord lipoma results in recurrences or pseudo-recurrences.

Both the European Association of Endoscopic Surgery and the International Endohernia Society (recommend an active search for spermatic cord lipomas in all laparo-endoscopic inguinal hernia repairs systematic review's  found that spermatic cord lipomas can be the cause of clinical symptoms that resemble symptoms of a hernia.

Removal of lipomas seems to relieve symptoms in the vast majority of patients.

Dissectionof the spermatic cord lipoma is recommended, while sparing the fatty tissue surrounding the spermatic cord structures. 

Since the fatty tissue of the spermatic cord lipoma has its origin in, and hence obtains its vascular supply from, the preperitoneal space, it can be either reduced or resected.Resection is only needed if post-reduction mesh placement is impeded. 

References:

1. Spermatic Cord Lipoma—A Review of the Literature: Ferdinand Köckerling* and Christine Schug-Pass

2. Why Spermatic Cord Lipomas Must be Treated as “True” Inguinal Hernias Christophe R. Berney

3. Intraoperative management of spermatic cord lipomas: a systematic review

Emily Piga, Sengül Gülen, Dennis Zetner, Kristoffer Andresen, Jacob Rosenberg, Center for Perioperative Optimization, Department of Surgery, Herlev and Gentofte Hospitals, University of Copenhagen, Herlev Ringvej 75, DK-2730 Herlev, Denmark

Dissectionof the spermatic cord lipoma is recommended, while sparing the fatty tissue surrounding the spermatic cord structures. 

Since the fatty tissue of the spermatic cord lipoma has its origin in, and hence obtains its vascular supply from, the preperitoneal space, it can be either reduced or resected. 

Resection is only needed if post-reduction mesh placement is impeded. 

References:

1. Spermatic Cord Lipoma—A Review of the Literature Ferdinand Köckerling* and Christine Schug-Pass

2. Why Spermatic Cord Lipomas Must be Treated as “True” Inguinal Hernias Christophe R. Berney

3. Intraoperative management of spermatic cord lipomas: a systematic review Emily Piga, Sengül Gülen, Dennis Zetner, Kristoffer Andresen, Jacob Rosenberg

Center for Perioperative Optimization, Department of Surgery, Herlev and Gentofte Hospitals, University of Copenhagen, Herlev Ringvej 75, DK-2730 Herlev, Denmark .

tags: hernia hernia surgery hernia surgery technique laparoscopic hernia repair laparoscopic hernia surgery Laparoscopic Inguinal Hernia laparoscopy Lipoma spermatic cord surgery cases surgical video cases


Julia Szlążek
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Julia Szlążek

MD

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