Giant Hernia: Hug and TOP Technique

Giant inguinoscrotal hernias have been defined as those that extend below the midpoint of the inner thigh with the patient in the standing position [1]. Giant inguinoscrotal hernias, with a significant secondary abdominal cavity, are infrequent in developed countries; nevertheless, on rare occasions, patients visit their clinician after years of neglect and refusing to admit their problem. Even among underserved populations, the incidence of giant inguinoscrotal hernias is less than that of large inguinoscrotal hernias: indeed, this evidences the real distinction between giant and large inguinoscrotal hernias. Giant inguinoscrotal hernias are not only those that extend below the midpoint of the inner thigh when the patient is standing but also those with an anteroposterior diameter of at least 30 cm and a laterolateral diameter of about 50 cm and have been not reducible for more than 10 years (Figs. 37.1 and 37.2).