Exploring the Incidence and Anatomical Distribution of Spermatic Cord Lipoma During Hernia Repair: A Ward-Based Study

Qandeel Fatima; Zahid Mehmood; Tanweer Ahmed; Maleha Salih; Sufyan Taufiq; Irfan Ali

doi:10.70749/ijbr.v3i7.1732

Authors

Qandeel Fatima Department of Surgical Unit 1, Ward 3, Jinnah Post Graduate Medical Centre, Karachi, Sindh, Pakistan.
Zahid Mehmood Professor of General Surgery, Ward 3, Jinnah Post Graduate Medical Centre, Karachi, Sindh, Pakistan.
Tanweer Ahmed Department of Surgical Unit 1, Ward 3, Jinnah Post Graduate Medical Centre, Karachi, Sindh, Pakistan.
Maleha Salih Department of Surgical Unit 1, Ward 3, Jinnah Post Graduate Medical Centre, Karachi, Sindh, Pakistan.
Sufyan Taufiq Department of Surgical Unit 1, Ward 3, Jinnah Post Graduate Medical Centre, Karachi, Sindh, Pakistan.
Irfan Ali Department of Surgical Unit 1, Ward 3, Jinnah Post Graduate Medical Centre, Karachi, Sindh, Pakistan.

DOI:

https://doi.org/10.70749/ijbr.v3i7.1732

Keywords:

Spermatic Cord Lipoma, Inguinal Hernia Repair, TAPP, Anatomical Distribution, Minimally Invasive Surgery

Abstract

Background: Spermatic cord lipomas, often overlooked during inguinal hernia repair, can mimic or accompany indirect hernias, potentially leading to postoperative complications if not identified and managed intraoperatively. This study aimed to evaluate the incidence and anatomical distribution of spermatic cord lipomas across different surgical modalities in a ward-based setting. Methods: A prospective observational study was conducted over 12 months (May 2024–April 2025) at Jinnah Postgraduate Medical Center, Karachi. A total of 140 male patients undergoing elective inguinal hernia repair were included. Surgical approaches comprised open repair (n=98), laparoscopic TAPP (n=22), and robotic TAPP (n=20). Intraoperative identification and localization of lipomas were recorded, categorized anatomically as precordial, midcordial, or proximal. Results: Spermatic cord lipomas were detected in 53 of 140 patients (37.9%). Incidence varied by surgical technique: robotic TAPP (50.0%), laparoscopic TAPP (45.5%), and open repair (33.7%). Midcordial location was most frequent (39.6%), followed by precordial (34.0%) and proximal (26.4%). Unilateral lipomas predominated (90.6%), while bilateral cases (9.4%) were exclusively identified via laparoscopic and robotic methods. No intraoperative complications related to lipoma dissection were reported. However, in cases where lipomas were missed or incompletely excised, postoperative complications such as recurrence, bulging, and persistent discomfort were noted during follow-up. Conclusion: Spermatic cord lipomas are a common intraoperative finding during inguinal hernia repair, especially in minimally invasive procedures where improved visualization enhances detection. Midcordial involvement is most prevalent, and bilateral cases may go unnoticed in open repairs. Standardized intraoperative evaluation of the spermatic cord is crucial to mitigate the risk of recurrence, postoperative bulging, and patient discomfort, thereby improving long-term outcomes.

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References

Haladu, N., Alabi, A., Brazzelli, M., Imamura, M., Ahmed, I., Ramsay, G., & Scott, N. W. (2022). Open versus laparoscopic repair of inguinal hernia: An overview of systematic reviews of randomised controlled trials. Surgical Endoscopy, 36(7), 4685-4700.

https://doi.org/10.1007/s00464-022-09161-6

Tran, H. M., MacQueen, I., Chen, D., & Simons, M. (2023). Systematic review and guidelines for management of scrotal inguinal hernias. Journal of Abdominal Wall Surgery, 2.

https://doi.org/10.3389/jaws.2023.11195

Dias, E. R., Amaral, P. H., Covas, D. G., Macret, J. Z., Carvalho, J. P., Pivetta, L. G., & Roll, S. (2024). Cord lipoma in minimally invasive surgical repairs of inguinal hernias: A prospective study. Hernia, 28(4), 1451-1455.

https://doi.org/10.1007/s10029-024-03080-2

Amato, G. (2022). Classification of inguinal hernias based on functional anatomy of the groin. Inguinal Hernia: Pathophysiology and Genesis of the Disease, 67-82.

https://doi.org/10.1007/978-3-030-95224-2_7

Rajeswaran, G. (2024). Imaging of groin pain. Medical Radiology, 259-274.

https://doi.org/10.1007/174_2024_497

Improta, L., Passa, R., Pagnoni, C., Angelucci, M., Alloni, R., & Valeri, S. (2024). Challenges, treatment strategies, and surgical techniques in the management of spermatic cord sarcomas. Annals of Surgical Oncology, 32(4), 2971-2978.

https://doi.org/10.1245/s10434-024-16748-x

Watson, C. (2023). Hernia. Ellis and Calne's Lecture Notes in General Surgery, 311-322.

https://doi.org/10.1002/9781394322008.ch31

Nishida, K., Ochiai, S., & Lefor, A. K. (2022). A “sacless hernia” with the orifice obscured by a preperitoneal lipoma: A case report. International Journal of Surgery Case Reports, 90, 106667.

https://doi.org/10.1016/j.ijscr.2021.106667

Karbasian, N., Segaran, N., Solomon, N., Pellerito, J. S., Katz, D. S., Moshiri, M., & Revzin, M. V. (2022). Pathologic conditions at imaging of the spermatic cord. RadioGraphics, 42(3), 741-758.

https://doi.org/10.1148/rg.210161

Forsmann, M., McLaughlin, D., & Leonard, T. (2022). A case report of scrotal lipoma and review of lipoma pathogenesis. Journal of surgical case reports, 2022(5), rjac214.

https://doi.org/10.1093/jscr/rjac214

Elnahhas, A., & Talaia, A. (2024). Intradural lipoma. Congenital Spine Malformations, 151-164.

https://doi.org/10.1007/978-3-031-59031-3_15

Favela, J. G., Argo, M. B., & Huerta, S. (2024). Well-differentiated liposarcoma of spermatic cord presenting as recurrent inguinal hernia: A case report. AME Case Reports, 8, 72-72.

https://doi.org/10.21037/acr-23-69

Hua, R., Zhao, L., Xu, L., Sun, J., Huang, J., & Hua, Q. (2023). Recurrent paratesticular giant liposarcoma: A case report and literature review. Frontiers in Surgery, 10.

https://doi.org/10.3389/fsurg.2023.1171952

Lim, J. X., Fong, E., Goh, C., Ng, L. P., Low, D. C., Seow, W. T., & Low, S. Y. (2024). Complex lumbosacral spinal cord lipomas: A longitudinal study on outcomes from a Singapore children’s hospital. Journal of Clinical Neuroscience, 121, 119-128.

https://doi.org/10.1016/j.jocn.2024.02.017

Perera, D., Craven, C. L., & Thompson, D. (2023). Lumbosacral lipoma in childhood, how strong is the evidence base? A systematic review. Child's Nervous System, 40(3), 715-728.

https://doi.org/10.1007/s00381-023-06203-9

Andreou, C., Maksimovic, S., Riboni, C., Eisner, L., Kudsi, O. Y., & Dietz, U. A. (2023). Laparoscopic TAPP to treat inguinal hernia. Is the robot preferable? A review and cohort-study on anatomical landmarks of robotic-assisted transabdominal preperitoneal groin hernia repair (r-TAPP). Cirugía Española, 101, S3-S10.

https://doi.org/10.1016/j.ciresp.2023.01.005

Wafa, T. A., El-Saied, A. W., Darwish, M., Elshafey, A., Elayoty, M., Elbatarny, A., Elsherbiny, M., & Sheir, H. (2024). Trans-abdominal pre-peritoneal (TAPP) approach for anatomical repair of direct inguinal hernia in children: Could it be the new standardized approach? Journal of Pediatric Surgery, 59(12), 161682.

https://doi.org/10.1016/j.jpedsurg.2024.08.022

Otto, J., Lindenau, T., & Junge, K. (2023). Hernia. Essentials of Visceral Surgery, 305-322.

https://doi.org/10.1007/978-3-662-66735-4_13