Importance of lipoma of the cord

[Beenthere]

Importance of lipoma of the cord

I missed your response. I wrote about some of the experience under Wisconsinherniadoc. Not sure if I should start a separate conversation for more of my experience. It was short being only two years but I had to fight the whole way to find the answers and have the original surgery redone. Thanks your interest.

[otzi]

Importance of lipoma of the cord

quote :

That may be the best short answer to the difference in why in open surgery it is removed and lap surgery it is not. This response should be a sticky. One more question on this is a lipoma the same as a hernia sac?

Not sure if you or anyone else would want to hear my op report and any of the history before and after the surgery.

Thanks again for the excellent response.

Beenthere, I would be interested in hearing your details and history before and after surgery, and I am sure other forum readers would as well. Hernias are clearly complex, and the more information out there the better in my view.

[sngoldstein]

Importance of lipoma of the cord

The lipoma is different from the hernia sac. The hernia sac is an extension of the peritoneum (the bag that holds the intestines) that looks like a bag or sack that extends through a hernia opening and may contain bowel. A lipoma of the cord is fat on the outside of peritoneum that is protruding the hernia opening. I know this is all very complicated and most doctors do not understand much, if any of the groin anatomy. It takes several months of surgery residency watching hernia surgeries before understanding starts to set in.

[Beenthere]

Importance of lipoma of the cord

That may be the best short answer to the difference in why in open surgery it is removed and lap surgery it is not. This response should be a sticky. One more question on this is a lipoma the same as a hernia sac?

Not sure if you or anyone else would want to hear my op report and any of the history before and after the surgery.

Thanks again for the excellent response.

[sngoldstein]

Importance of lipoma of the cord

A hernia is simply a hole in the abdominal wall. It is when something pokes through the hole there is a problem. If intestines poke through the hole, they can get pinched which is what causes a bowel obstruction. If there is only fat in the hole, we call that a lipoma of the cord. A sliding hernia is defined as when intestines are part of the hernia sac, so if you had a small hernia, it was not a slider. It sounds like you had a small hole with some fat in it which we often find when operating on someone with groin pain and no bulge. To fix this you remove the fat and close the hole. The fat does nothing except plug the hole and there are no side effects to removing it. In an open operation it is easier to excise the fat since it originates from inside the body. Once the fat is out of the way, you can see up the hole or put a mesh patch over it. The theoretical disadvantages of the anterior open approach are that sutures are required which can injure nerves or cause tension on nerves which causes pain. When patching the hole from the inside, in a laparoscopic repair, you pull the fat out of the hole from the inside. Since it is still attached to its blood supply, there is no need to remove it. In general, we are talking about something smaller than a grape. After the fat is removed, the hole is covered with a mesh patch. Since the natural pressure of the abdominal contents holds the mesh in place, like a patch between a tire and the tube, sutures are not necessary and there is less risk of injuring a nerve. If this still makes no sense, look at the hernia video on my website, http://www.littlescars.com.

[Beenthere]

Importance of lipoma of the cord

I guess I am a little confused and it does not take much for that to happen me. In Dr Goldstein response 2 days ago “They can produce the same symptoms as any hernia except for bowel obstruction because they push on nerves and can even strangulate which causes severe pain as the fat dies. There is no difference between a cord lipoma and a fat containing hernia.” If the Lipoma can cause severe pain and bowel obstruction , why than is it mostly removed during open surgery “and not removed during laparoscopic repair because it is not necessary.”?

So in my case I was told after the surgery that I had an direct/indirect sliding hernia with removal of lipoma. Can that all be happening on the same side without any pain or bulge?

Plus what about the pathology and side effects or complication of removal of lipoma?

Thanks

[sngoldstein]

Importance of lipoma of the cord

Both open and laparoscopic repair should adequately treat a cord lipoma. I am a lap surgeon and feel that approach works best but if your surgeon is more comfortable open, that will also give good results.

[otzi]

Importance of lipoma of the cord

Does this suggest that open surgery is better for patients with small fat containing hernias or lipomas that cause pain? Would the fat not be seen or accessible in an inguinal laparoscopic repair and that is why it’s not removed in laparopscopic approach?

[sngoldstein]

Importance of lipoma of the cord

Cord “lipomas” are not really lipomas like tumors in your arm or leg. They are preperitoneal fat that has herniated through the internal ring. They are usually removed during open hernia surgery and not removed during laparoscopic repair because it is not necessary. They can produce the same symptoms as any hernia except for bowel obstruction because they push on nerves and can even strangulate which causes severe pain as the fat dies. There is no difference between a cord lipoma and a fat containing hernia.

[Beenthere]

Importance of lipoma of the cord

If a lipoma is found in 23% of the cases, do you bring this up in your pre surgical consult to the patient?

Is that 23% in males only or all 23% of all inguinal hernia surgeries, meaning in males the number is closer to 50%?

Do you send all lipomas to pathology?

Any complications to removing a lipoma?

[drtowfigh]

Importance of lipoma of the cord

Both cord lipoma and inguinal hernia may cause groin symptoms. Usually they occur together. Repair typically involves addressing both of them at the same time.

[RJ]

Importance of lipoma of the cord

quote :

Ultrasound does not reliably differentiate cord lipoma from fat-containing hernia.

This may be a silly question then, but if a fat-containing hernia and cord lipoma look the same on ultrasound, can anyone tell them apart before surgery? Do they differentiate clearly in MRI or CT imagery?

Can a cord lipoma be asymptomatic and a random finding, whereas a hernia is maybe more likely to cause sudden pain onset or general aggravation? Or are they both possible to be causing inguinal symptoms in a patient?

[drtowfigh]

Importance of lipoma of the cord

^uAhah! You have been doing your research.

This article is just another example of complications that can occur when you have not yet met the steep learning curve for laparoscopic surgery. Lipomas of the spermatic cord can very effectively be removed at the time of laparoscopy unless they are very deep into the scrotum, but it must be part of the checklist of things to do while performing the dissection.

Ultrasound does not reliably differentiate cord lipoma from fat-containing hernia.