News Feed Discussions Fat In Inguinal Canal

  • Fat In Inguinal Canal

    Posted by pmv on January 31, 2020 at 7:52 pm

    Pelvic MRI per @drtowfigh 3T valsalva protocol (1 year after robotic inguinal hernia surgery for direct defect implanted with ProGrip mesh) revealed “stable fat in inguinal canal with no evidence of inducibility”

    Can you please interpret this impression for me.

    Thanks

    drtowfigh replied 4 years, 1 month ago 4 Members · 11 Replies
  • 11 Replies
  • drtowfigh

    Moderator
    February 8, 2020 at 9:31 am

    @pmv Sounds like you have an inguinal hernia. If it’s not symptomatic there is no strong reason to address it surgically.

  • pmv

    Member
    February 3, 2020 at 10:48 am

    Thank you @drtowfigh.

    My valsalva protocol 3T MRI (1 year after robotic inguinal hernia repair on my left side & ProGrip mesh implant) states that there is fat in my left inguinal canal which is “stable” “without evidence of inducibility.”

    Is this different from a “spermatic cord lipoma”? (It seems as though a lot of terminology is used interchangeably.)

    What is the significance of stable fat in the inguinal canal without inducibility, if there is no visible bulge and no pain in that immediate area?

    Why is it difficult to remove a spermatic cord lipoma laparoscopically?

    Would you ever recommend surgery for stable inguinal canal fat without evidence of inducibility that isn’t causing a visible bulge or any pain in the immediate area?

    Thank you.

  • drtowfigh

    Moderator
    February 3, 2020 at 5:21 am

    Usually by imaging.

  • Alephy

    Member
    February 3, 2020 at 4:31 am

    I wonder, can a lipoma be assessed before surgery, and if so are they treated even if not painful or in this case they are left alone?

  • drtowfigh

    Moderator
    February 3, 2020 at 3:56 am

    Thanks for tagging me.

    A spermatic cord lipoma May or may not be painful. We remove them as part of a complete hernia repair. Sometimes they can be missed or difficult to remove from laparoscopic approach.

    They can present as a groin bulge.

    It would be uncommon to have a huge symptomatic lipoma without an associated hernia. Most lipomas are actually linked to the preperitoneal fat. The one exception is if there is a hernia repair and the fat is missed. In that case, what used to be a mobile, non painful lipoma is now trapped in the inguinal canal by the mesh upstream. This can cause pressure and thus pain. The treatment is to remove the lipoma and that is a fairly straightforward procedure done open.

    • This reply was modified 4 years, 1 month ago by  drtowfigh.
  • pmv

    Member
    February 1, 2020 at 6:54 pm

    Hopefully, @drtowfigh can let us know (1) how fat gets into the inguinal canal, (2) the clinical significance of a lipoma in the inguinal canal with the abdominal Wall intact, (3) should lipoma (fat) in the inguinal canal be treated and, if so, how?

  • pmv

    Member
    February 1, 2020 at 6:48 pm

    @good-intentions thank you.

    You are very knowledgeable.

    Are you a medical doctor?

    Do you know if inguinal canal fat lipomas are benign? I know @drtowfigh has stated that fat in the inguinal canal can result in pain. Is this true even if the abdominal wall is intact?

    According to the MRI report, the “stable fat in the inguinal canal without evidence of inducibility” is on the same side as the ProGrip mesh.

  • Good intentions

    Member
    February 1, 2020 at 11:33 am

    Let’s see if Notifications work. @good-intentions @pmv @alephy
    Nothing came up for pmv for some reason.

  • Good intentions

    Member
    February 1, 2020 at 11:09 am

    I think that a lipoma actually looks more like just a thick spot on the spermatic cord. It is in the proper space as the cord so does not show the physical signs of a hernia. The abdominal wall is intact.

    You can read the basic descriptions of hernia procedures and you’ll find that they typically just peel the fat off of the cord, if they find it. If you read the link I provided you’ll see that they can be difficult to identify, even during a laparoscopic examination.

    Excerpt from the article –
    “Lipomas of the cord and round ligament occur with a significant incidence. They can cause hernia-type symptoms in the absence of a true hernia (associated with a peritoneal defect). They should be considered in the patient with groin pain and normal examination results. They can be easily overlooked at the time of laparoscopic hernia repair, and this can lead to an unsatisfactory result.”

  • Alephy

    Member
    February 1, 2020 at 11:01 am

    Can a lipoma present with also a lump like an inguinal hernia? What is the treatment for a lipoma (or what should it be,I am pretty sure the average surgeon would put a mesh for that too)?

  • Good intentions

    Member
    February 1, 2020 at 10:36 am

    Is it the same side as the mesh implant? Inducible basically means “able to be moved” or similar. Since you had an active MRI, with the valsalva maneuver I think what it means is the the “fat” did not move when you performed the maneuver. Probably because it is stuck to the spermatic cord, a lipoma.

    If it’s on the same side as the mesh it might mean that the surgeon either did not check the spermatic cord and canal for a lipoma (fat suck to the cord) or just missed it in your case. It’s not clear (to me) how the fat gets in to the canal, but, apparently, lipomas and indirect hernias are defined differently. Anyway, they are usually found during the hernia repair, and can cause pain similar to a “true” hernia.

    Here is one article that I found. Search “hernia lipoma” and you’ll find a bunch more.

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1422475/

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