Laparoscopic treatment for adult inguinal hernia with cryptorchidism: A case report

Abstract

Introduction:
Cryptorchidism or undescended testis is the most common disorder of male children, which is often diagnosed and treated during childhood. Adult patients with cryptorchidism are uncommon. Herein we report the case of adult inguinal hernia with cryptorchidism successfully treated by laparoscopic surgery simultaneously.

Presentation of case:
We report a case of 68 year-old-man who was admitted to our hospital with a complaint of bulge and pain in the right groin area from 2 weeks before. CT or MRI revealed a right inguinal hernia and an undescended testis in the right inguinal canal. He was diagnosed with right inguinal hernia accompanied by cryptorchidism. Laparoscopic transabdominal preperitoneal repair (TAPP) and orchiectomy were performed simultaneously. Postoperative period was uneventful and he was discharged home on the 1st postoperative day. Pathological examination of the specimen was reported as atrophic testis with no malignancy. There has been no recurrence during a follow-up.

Discussion:
To our Knowledge, the case report of adult inguinal hernia with cryptorchidism treated by laparoscopic surgery is rare. All cases recommended the feasibility of laparoscopic surgery.

Conclusion:
Adult inguinal hernia with cryptorchidism is a rare condition. TAPP and simultaneous laparoscopic orchiectomy for inguinal hernia with cryptorchidism were safe and feasible. It could be the first surgical option for the treatment of such adult patients.

Full text

CASE
REPORT
–
OPEN
ACCESS
International
Journal
of
Surgery
Case
Reports
75
(2020)
46–49
Contents
lists
available
at
ScienceDirect
International
Journal
of
Surgery
Case
Reports
j
ourna
l
h
om
epage:
www.casereports.com
Laparoscopic
treatment
for
adult
inguinal
hernia
with
cryptorchidism:
A
case
report
Masakazu
Wakabayashi∗,
Kana
Aoki,
Hayato
Yoshida,
Tomohiro
Kimura,
Yoshinori
Domoto,
Miki
Hosaka,
Kentarou
Funatsu,
Kazuo
Aisaki,
Takeo
Hokari
Department
of
Surgery,
Sagamihara
Kyodo
Hospital,
Japan
a
r
t
i
c
l
e
i
n
f
o
Article
history:
Received
25
July
2020
Accepted
2
September
2020
Available
online
6
September
2020
Keywords:
Inguinal
hernia
Cryptorchidism
Laparoscopic
surgery
TAPP
Orchiectomy
a
b
s
t
r
a
c
t
INTRODUCTION:
Cryptorchidism
or
undescended
testis
is
the
most
common
disorder
of
male
children,
which
is
often
diagnosed
and
treated
during
childhood.
Adult
patients
with
cryptorchidism
are
uncom-
mon.
Herein
we
report
the
case
of
adult
inguinal
hernia
with
cryptorchidism
successfully
treated
by
laparoscopic
surgery
simultaneously.
PRESENTATION
OF
CASE:
We
report
a
case
of
68
year-old-man
who
was
admitted
to
our
hospital
with
a
complaint
of
bulge
and
pain
in
the
right
groin
area
from
2
weeks
before.
CT
or
MRI
revealed
a
right
inguinal
hernia
and
an
undescended
testis
in
the
right
inguinal
canal.
He
was
diagnosed
with
right
inguinal
hernia
accompanied
by
cryptorchidism.
Laparoscopic
transabdominal
preperitoneal
repair
(TAPP)
and
orchiec-
tomy
were
performed
simultaneously.
Postoperative
period
was
uneventful
and
he
was
discharged
home
on
the
1st
postoperative
day.
Pathological
examination
of
the
specimen
was
reported
as
atrophic
testis
with
no
malignancy.
There
has
been
no
recurrence
during
a
follow-up.
DISCUSSION:
To
our
Knowledge,
the
case
report
of
adult
inguinal
hernia
with
cryptorchidism
treated
by
laparoscopic
surgery
is
rare.
All
cases
recommended
the
feasibility
of
laparoscopic
surgery.
CONCLUSION:
Adult
inguinal
hernia
with
cryptorchidism
is
a
rare
condition.
TAPP
and
simultaneous
laparoscopic
orchiectomy
for
inguinal
hernia
with
cryptorchidism
were
safe
and
feasible.
It
could
be
the
first
surgical
option
for
the
treatment
of
such
adult
patients.
©
2020
The
Authors.
Published
by
Elsevier
Ltd
on
behalf
of
IJS
Publishing
Group
Ltd.
This
is
an
open
access
article
under
the
CC
BY-NC-ND
license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
1.
Introduction
Cryptorchidism
or
undescended
testis
is
the
most
common
disorder
of
male
children,
which
is
often
diagnosed
and
treated
during
childhood.
The
standard
therapy
is
surgical
repositioning
of
the
testis
within
the
scrotal
sac
(orchidopexy)
for
children,
and
orchiectomy
for
adult
patients
because
of
the
risks
of
torsion
and
malignant
formation
and
less
fertility.
Adult
patients
with
cryp-
torchidism
are
uncommon,
and
with
inguinal
hernia
are
very
rare
condition.
Herein
we
report
the
case
of
adult
inguinal
hernia
with
cryptorchidism
successfully
treated
by
laparoscopic
surgery
simul-
taneously.
The
work
has
been
reported
in
line
with
the
SCARE
criteria
and
cite
the
following
paper
in
my
references
[1].
2.
Presentation
of
case
We
report
a
case
of
68
year-old-man
who
was
admitted
to
our
hospital
with
a
complaint
of
bulge
and
pain
in
the
right
groin
∗Corresponding
author
at:
Department
of
Surgery,
Sagamihara
Kyodo
Hospital,
2-8-18
Hashimoto,
Midori-ku,
Sagamihara-shi,
Kanagawa,
252-5188,
Japan.
E-mail
address:
mw5636@gmail.com
(M.
Wakabayashi).
area
from
2
weeks
before.
Physical
examination
showed
a
right
groin
bulge
and
non-palpable
testis
in
the
scrotum.
Ultrasound
test,
CT
and
MRI
revealed
a
right
inguinal
hernia
and
an
unde-
scended
testis
in
the
right
inguinal
canal
(Figs.
1
and
2).
He
was
evaluated
in
Urology
and
General
Surgery
and
was
diagnosed
with
right
inguinal
hernia
accompanied
by
cryptorchidism.
TAPP
for
right
inguinal
hernia
and
laparoscopic
orchiectomy
for
right
cryp-
torchidism
were
performed
simultaneously.
With
the
patient
in
the
spine
position
after
induction
of
general
anesthesia,
three
tro-
cars
were
placed
through
the
abdominal
wall.
The
first
trocar
was
placed
into
the
umbilicus
for
the
laparoscope.
After
making
a
pneu-
moperitoneum,
the
next
two
trocars
were
placed
into
the
right
and
left
middle
abdomen
for
the
operator.
Laparoscopic
findings
showed
the
right
indirect
inguinal
hernia
and
the
hernia
orifice
was
2
cm
sized
in
diameter
(Fig.
3).
Pulling
the
hernial
sac
back
to
the
abdominal
cavity,
we
could
find
out
the
intracanalicular
testis
along
with
a
spermatic
cord
and
a
testicular
vessels,
then
they
were
cut
and
ligated
(Fig.
4).
The
testis
was
extracted
through
the
umbilical
port
site,
after
the
incision
was
extended
to
2
cm.
Next
to
laparoscopic
right
orchiectomy,
TAPP
for
right
inguinal
hernia
was
performed.
The
operation
time
was
81
min
and
little
blood
loss
was
observed.
Postoperative
period
was
uneventful
and
the
patient
was
discharged
home
on
the
1st
postoperative
day.
Pathological
exam-
https://doi.org/10.1016/j.ijscr.2020.09.008
2210-2612/©
2020
The
Authors.
Published
by
Elsevier
Ltd
on
behalf
of
IJS
Publishing
Group
Ltd.
This
is
an
open
access
article
under
the
CC
BY-NC-ND
license
(http://
creativecommons.org/licenses/by-nc-nd/4.0/).

CASE
REPORT
–
OPEN
ACCESS
M.
Wakabayashi
et
al.
/
International
Journal
of
Surgery
Case
Reports
75
(2020)
46–49
47
Fig.
1.
Horizontal
abdominal
CT.
Horizontal
abdominal
CT
shows
a
right
inguinal
hernia
and
an
undescended
testis
in
the
right
inguinal
canal
(arrowhead).
Fig.
2.
Sagittal
abdominal
MRI.
Sagittal
abdominal
MRI
shows
a
right
inguinal
hernia
and
an
undescended
testis
in
the
right
inguinal
canal
(arrowhead).
ination
of
the
specimen
was
reported
as
atrophic
testis
with
no
malignancy.
There
has
been
no
recurrence
during
a
follow-up.
3.
Discussion
Cryptorchidism
or
undescended
testis
is
the
most
common
dis-
order
of
male
children,
which
is
often
diagnosed
and
treated
during
childhood.
The
incidence
of
cryptorchidism
ranges
between
3.4%
and
5.8%
in
full-term
boys
and
30%
in
premature
boys
[2].
Clinical
diagnosis
of
cryptorchidism
is
not
so
difficult
because
of
non-
palpable
testis
in
the
scrotum.
Ultrasound
test,
CT
and
MRI
are
also
used
for
diagnosis
of
an
undescended
testis.
But
if
sometimes
they
Fig.
3.
Laparoscopic
surgical
findings.
The
right
indirect
inguinal
hernia
was
found.
The
hernia
orifice
was
2
cm
sized
in
diameter.
Fig.
4.
Laparoscopic
surgical
findings.
The
intracanalicular
testis
along
with
a
spermatic
cord
and
a
testicular
vessels
was
safely
removed.
can’t
show
an
undescended
testis,
laparoscopy
has
the
benefit
of
being
both
diagnostic
and
therapeutic.
Adult
patients
with
cryptorchidism
are
uncommon
and
at
increased
risk
for
gonadal
malignancy
and
infertility.
Therefore,
the
standard
therapy
is
surgical
repositioning
of
the
testis
within
the
scrotal
sac
(orchidopexy)
for
children,
and
orchiectomy
for
adult
patients
because
of
the
risks
of
torsion
and
malignant
formation
and
less
fertility.
In
addition,
adult
patients
who
present
with
cryp-
torchidism
and
inguinal
hernia
should
be
treated
both
diseases.
For
such
patients,
laparoscopic
surgery
can
be
very
useful
with
high
diagnostic
ability
for
the
location
of
the
undescended
testis,
less
incision
and
aesthetic
advantage.
To
date,
we
identified
a
total
of
11
reports
of
laparoscopic
repair
for
adult
inguinal
hernia
with
cryptorchidism
including
our
case
using
the
keywords
“inguinal
hernia”,
“adult”,
“laparo-
scopic
surgery”,
“cryptorchidism”
or
“undescended
testis”
based
on
PubMed
search
for
all
English
articles
(Table
1).
3
reports
are
the
case
series
from
Turkey
and
India.
The
authors
described
that
some
people
with
undescended
testis
in
developing
countries
such
as
Turkey
or
India,
present
late
because
they
have
not
been
treated

CASE
REPORT
–
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48
M.
Wakabayashi
et
al.
/
International
Journal
of
Surgery
Case
Reports
75
(2020)
46–49
Table
1
Reported
cases
of
adult
inguinal
hernia
with
cryptorchidism
treated
by
laparoscopic
surgery.
No.
Year
Author
Age
Type
of
inguinal
hernia
Type
of
cryptochidism
Operation
for
hernia
Operation
for
cryptochidism
Operation
time
(min)
Blood
loss
(ml)
Post
operative
hospital
stay
(day)
Complications
1
1994
Banwell
et
al.
[8]
25,
61
(2
cases)
right
/
indirect
right
/
intraabdominal
TAPP
orchiectomy
NS
NS
1
none
2
1995
de
la
Torre
et
al.
[9]22
right
/
indirect right
/
intracanalicular
TAPP
orchiectomy
NS
NS
NS
NS
3
2002
Ansari
et
al.
[10]
30
bilateral
/
indirect
bilateral
/
intraabdominal
TAPP
right
orchidopexy
left
orchiectomy
210
little
1
none
4
2003
Sahin
et
al.
[3] 20–27
(44
cases) various
various
/
35
intraabdominal,
7
intracanalicular
TAPP
orchiectomy
45–80 NS
1–2
2
pneumoscrotum
5
2004
Vijjan
et
al.
[4]
12–28
(4
cases)
left
3,
right
1
/
indirect
various
/
intraabdominal
TAPP
orchiectomy
or
orchidopexy
NS
NS
NS
NS
6
2007
Rangarajan
et
al.
[5]
26–38
(11
cases)
various
various
TAPP
orchiectomy
NS
NS
1
none
7
2008
Rhee
et
al.
[11]
35
right
/
indirect
left
/
intraabdominal
TAPP
orchiectomy
NS
NS
0
none
8
2014
Birol
et
al.
[6]22
left
/
indirect right
/
intracanalicular
TEP
orchiectomy
NS
NS
1
none
9
2015
Fujishima
et
al.
[7] 49,
38
(2
cases) right
/
indirect
right
/
intracanalicular
TEP
orchiectomy
124,
112
little
6,
4
none
10
2017
Omoto
et
al.
[12]
53
right
/
indirect
right
/
intraabdominal
TAPP
orchidopexy
228
little
4
none
11
2020
our
case
68
right
/
indirect
right
/
intracanalicular
TAPP
orchiectomy
81
little
1
none
NS:
not
stated,
TAPP:
transabdominal
preperitoneal
repair,
TEP:
totally
extraperitoneal
repair.
due
to
ignorance,
relative
inaccessibility
of
health
care
or
socioeco-
nomic
factors
[3–5].
The
age
of
most
cases
were
between
20
and
30,
and
our
case
was
68
years
old,
the
oldest
male
in
the
already
pub-
lished
cases
before.
The
type
of
cryptorchidism
was
classified
into
intraabdominal
(testis
is
identified
in
the
abdominal
cavity)
and
intracanalicular
(testis
is
identified
in
the
inguinal
canal
and
normal
cord
structures
entering
the
inguinal
ring
is
observed)
according
to
its
localization.
Almost
all
the
cases
were
into
the
category,
but
in
a
few
cases,
the
testis
is
not
identified
and
blind-ending
vessels
were
observed
[3–5].
2
reports
presented
with
totally
extraperi-
toneal
repair
(TEP)
[6,7],
and
9
reports
described
TAPP
[8–12]
for
an
inguinal
hernia.
The
standard
operation
for
cryptorchidism
are
orchiectomy
or
orchidopexy.
Laparoscopic
orchidopexy
was
per-
formed
in
3
reports
despite
orchiectomy
is
recommended
for
adult
case
[4,10,12].
The
reasons
were
patient’s
will
under
the
informed
consent
or
the
idea
that
malignancy
rate
is
not
unacceptably
high.
Simultaneous
laparoscopic
management
of
an
undescended
testis
and
an
associated
inguinal
hernia
could
be
undertaken
safely
with-
out
the
need
to
convert
to
an
open
surgery
for
all
cases.
The
mean
post
operative
hospital
stay
was
a
day.
The
operative
complications
were
two
cases
of
pneumoscrotum,
but
they
recovered
completely
after
24
h
[4].
No
other
major
complications
were
reported.
We
opted
for
the
simultaneous
laparoscopic
surgery
with
early
diagnosis
of
right
inguinal
hernia
with
cryptorchidism
by
medical
imagings
like
CT
or
MRI,
getting
the
benefits,
minimal
invasiveness,
aesthetic
advantage
and
early
recovery.
The
operation
was
com-
pleted
in
81
min
with
little
blood
loss.
The
patient
was
discharged
home
on
the
1st
postoperative
day,
and
there
were
no
complica-
tions
during
either
the
perioperative
or
the
postoperative
process.
We
believe
the
results
to
be
acceptable
for
a
treatment
including
inguinal
hernia
repair
and
orchiectomy.
All
authors
indicated
that
the
laparoscopic
repair
of
inguinal
hernia
with
cryptorchidism
resulted
in
less
postoperative
pain,
ear-
lier
recovery,
shorter
hospital
stay,
cosmetic
satisfaction.
4.
Conclusion
TAPP
and
simultaneous
laparoscopic
orchiectomy
for
inguinal
hernia
with
cryptorchidism
were
safe
and
feasible.
It
could
be
the
first
surgical
option
for
the
treatment
of
such
adult
patients.
Funding
No
funding.
Ethical
approval
Institutional
review
board
approval
was
exempt
from
our
insti-
tution
because
all
data
were
collected
from
clinical
records
and
imaging
systems
for
routine
preoperative
planning
and
follow
up.
Consent
Informed
consent
was
obtained
from
the
patient
for
publication
of
this
case
report
and
any
accompanying
images.
Author
contribution
MW
performed
the
surgery,
and
is
the
first
author
and
prepared
the
manuscript.
KA,
HY,
TK,
YD,
MH,
KF,
KA,
and
TH
who
performed
perioperative
therapy
have
read
and
approved
the
final
manuscript.
Registration
of
research
studies
This
paper
is
not
research
study.

CASE
REPORT
–
OPEN
ACCESS
M.
Wakabayashi
et
al.
/
International
Journal
of
Surgery
Case
Reports
75
(2020)
46–49
49
Guarantor
Dr.
Takeo
Hokari.
Provenance
and
peer
review
Not
commissioned,
externally
peer-reviewed.
Declaration
of
Competing
Interest
The
authors
report
no
declarations
of
interest.
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