Spermatic cord lipomas : a common finding but a subtle one

الملخص EN

True lipomas of the spermatic cord, as defined in surgical pathology textbooks, are rarely encountered during inguinal hernial surgical repair procedures.

The most commonly encountered finding is a prolongation and/or extention of the retroperitoneal fat through the deep inguinal ring along or within the spermatic cord contents.

This study tries to investigate the incidence, clinical significance and the best methods to predict the presence of the misnamed lipomas of the spermatic cord versus the true lipomas of the spermatic cord using classical open Lichtenstein and laparoscopic hernioplasty.

A retrospective study of the records of (150) patients submitted to (160) surgical intervention for open/laparoscopic hernioplasty over a period of three years had been thoroughly investigated.

Hernioplasty was conducted using laparoscopic total extraperitoneal (TEP) in (50 = 31.

25 %) cases while the remaining (110 = 68.

75 %) cases were managed using open Liechtenstein hernioplasty.

The study showed that the ratio of indirect: direct inguinal hernia was (2.

33 : 1).

The proportion of right: left: bilateral inguinal hernias was (5.

78 : 3.

12 : 1).

The incidence of spermatic cord lipomas was (20 = 12.

5 %) cases.

Among these spermatic cord lipomas only (2 = 1.

25 %) cases were true lipomas in terms of surgical pathology.

There is some difficulty in clinical diagnosis of these lipomas and it is easy to be misdiagnosed as cases of irreducible and/or obstructed inguinal hernias.

Spermatic cord lipomas can cause symptoms similar to that of inguinal hernia with the absence of any associated hernial sac.

It is easy to miss these lipomas when using laparoscopic hernioplasty especially when employing the procedure of (TAPP) with the persistence of the preoperative symptoms.

Such postoperative complaints may constitute a source of problematic distress to the laparoscopic surgeon.

Accordingly, surgeons should be aware of the possible co-existance of spermatic cord lipomas during any type of inguinal hernioplasty