Incidental Discovery of Complications of Cryptorchidism During Laparoscopic Inguinal Hernia Surgery

TL;DR

Two adult cases of cryptorchidism were discovered during hernia surgery, requiring surgical adjustments and management.

Contribution

Highlights the importance of intraoperative assessment and management of cryptorchidism discovered during hernia repair in adults.

Findings

Cryptorchidism was incidentally discovered during laparoscopic hernia surgery in two adult patients.

Orchiopexy was performed in one case to temporarily manage the undescended testis.

Mesh-based hernia repair was safely used alongside cryptorchidism management.

Abstract

Background: Cryptorchidism is one of the most common congenital anomalies in newborn males, with the majority diagnosed in infancy and treated surgically before puberty. In some cases, cryptorchid testes are discovered incidentally during inguinal hernia repair in adults, requiring appropriate management at the time of surgery.

Case Presentation: Case 1: A 58-year-old male underwent emergency laparoscopic surgery for a left incarcerated hernia. Intraoperatively, an M2 indirect inguinal hernia with omental strangulation of the spermatic cord was identified. Despite attempts to pull the testis down manually, it did not descend into the scrotum, leading to the diagnosis of cryptorchidism. The spermatic cord was excised and a 3D mesh was placed to cover the hernia defect. Case 2: A 33-year-old man with Noonan syndrome presented with localized pain and swelling in the right groin. Laparoscopy revealed an indirect L3 inguinal hernia and incidentally an intra-abdominal testis was found. The testis and spermatic vessels were found to terminate intra-abdominally, confirming the diagnosis of cryptorchidism. An orchiopexy was performed to secure the testis subcutaneously in the scrotum and the hernia was repaired with a 3D mesh.

Conclusion: The safety of mesh-based hernia repair in cases of cryptorchidism with concomitant inguinal hernia has been previously reported. In cases where preoperative palpation is difficult due to pain, intraoperative traction of the testis may help differentiate between cryptorchidism and retractile testis. In addition, orchiopexy may serve as a temporary measure, with consideration of staged orchiectomy if necessary.

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