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Nakamura K, Higashiguchi T, Chikaishi Y, Matsuo K, Endo T, Morohara K, Kikuchi K, Shibasaki S, Katsuno H, Uyama I, Suda K, Morise Z. Totally laparoscopic surgery for a hydrocele of the canal of Nuck extending from the abdominal cavity to the subcutaneous space: a case report. Surg Case Rep 2024; 10:31. [PMID: 38302668 PMCID: PMC10834912 DOI: 10.1186/s40792-024-01825-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 01/18/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Hydrocele of the canal of Nuck (HCN) is a rare disease, and its indications for laparoscopic surgery are not well-established. CASE PRESENTATION A 53-year-old woman was referred to our hospital due to an uncomfortable thumb-sized inguinal mass. Preoperative computed tomography scan and magnetic resonance imaging revealed a hydrocele extending from the abdominal cavity around the left deep inguinal ring via the inguinal canal to the subcutaneous space. The patient was diagnosed with HCN protruding into the abdominal cavity and extending to the subcutaneous space. Laparoscopy can easily access the hydrocele protruding into the abdominal cavity. Furthermore, laparoscopic hernioplasty can be superior to the anterior approach for females. Hence, laparoscopic surgery was performed. After transecting the round ligament of the uterus, a tense 3-cm hydrocele was dissected with it. In order to approach the hydrocele distal to the deep inguinal ring, the transversalis fascia was incised medially to the inferior epigastric vessels. The subcutaneously connected hydrocele was excised from the incision. Then, the enlarged deep inguinal ring was reinforced using a mesh with the laparoscopic transabdominal preperitoneal approach. The patient was discharged 2 days postoperatively. Laparoscopic resection can be more effective for a hydrocele protruding into the abdominal cavity as it facilitates an easy access to the hydrocele. Moreover, laparoscopic resection of a hydrocele extending from the inguinal canal to the subcutaneous space via a transversalis fascia incision can be safer, with low risk of injury to the inferior epigastric vessels. The incised transversalis fascia and the enlarged deep inguinal ring due to the HCN were simultaneously repaired with the laparoscopic transabdominal preperitoneal repair. There are two reports on laparoscopic resection via a transversalis fascia incision for HCNs located between the inguinal canal and the subcutaneous space, which does not require intraperitoneal hydrocelectomy. However, this is the first report on laparoscopic resection of large HCNs protruding into the abdominal cavity and extending beyond the inguinal canal into the subcutaneous space via intraperitoneal hydrocelectomy and a transversalis fascia incision. CONCLUSIONS Laparoscopic surgery with transversalis fascia incision can be useful for HCNs extending from the abdominal cavity to the subcutaneous space.
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Affiliation(s)
- Kenichi Nakamura
- Department of Surgery, Fujita Health University Okazaki Medical Center, 1 Azakotanda, Harisaki, Okazaki, Aichi, 444-0827, Japan.
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
| | - Takahiko Higashiguchi
- Department of Surgery, Fujita Health University Okazaki Medical Center, 1 Azakotanda, Harisaki, Okazaki, Aichi, 444-0827, Japan
| | - Yuko Chikaishi
- Department of Surgery, Fujita Health University Okazaki Medical Center, 1 Azakotanda, Harisaki, Okazaki, Aichi, 444-0827, Japan
| | - Kazuhiro Matsuo
- Department of Surgery, Fujita Health University Okazaki Medical Center, 1 Azakotanda, Harisaki, Okazaki, Aichi, 444-0827, Japan
| | - Tomoyoshi Endo
- Department of Surgery, Fujita Health University Okazaki Medical Center, 1 Azakotanda, Harisaki, Okazaki, Aichi, 444-0827, Japan
| | - Koji Morohara
- Department of Surgery, Fujita Health University Okazaki Medical Center, 1 Azakotanda, Harisaki, Okazaki, Aichi, 444-0827, Japan
| | - Kenji Kikuchi
- Department of Surgery, Fujita Health University Okazaki Medical Center, 1 Azakotanda, Harisaki, Okazaki, Aichi, 444-0827, Japan
| | - Susumu Shibasaki
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Hidetoshi Katsuno
- Department of Surgery, Fujita Health University Okazaki Medical Center, 1 Azakotanda, Harisaki, Okazaki, Aichi, 444-0827, Japan
| | - Ichiro Uyama
- Department of Surgery, Fujita Health University Okazaki Medical Center, 1 Azakotanda, Harisaki, Okazaki, Aichi, 444-0827, Japan
- Advanced Robotic and Endoscopic Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
- Collaborative Laboratory for Research and Development in Advanced Surgical Technology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Koichi Suda
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
- Collaborative Laboratory for Research and Development in Advanced Surgical Intelligence, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Zenichi Morise
- Department of Surgery, Fujita Health University Okazaki Medical Center, 1 Azakotanda, Harisaki, Okazaki, Aichi, 444-0827, Japan
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Lee SR. Laparoscopic Hydrocelectomy of Encysted Hydrocele of the Canal of Nuck with High Ligation in Children or Iliopubic Tract Repair in Adults. J Laparoendosc Adv Surg Tech A 2022; 32:684-689. [PMID: 35446148 DOI: 10.1089/lap.2022.0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Encysted hydrocele of the canal of Nuck (EHCN) is homologous to spermatic cord hydrocele in males. EHCN causes swelling in the inguinal region and should be considered in the differential diagnosis of inguinal hernias and masses in females. Complete excision and internal inguinal ring closure are the recommended treatments for symptomatic EHCN. In this study, we aimed at evaluating the safety and feasibility of laparoscopic hydrocelectomy, as well as age-appropriate procedures for EHCN. Materials and Methods: The medical records of 161 female adults and children, who underwent laparoscopic transabdominal hydrocelectomy from January 2014 to December 2020 at a single institution, were reviewed retrospectively and symptoms, location of EHCN, type of fluid in EHCN, postoperative complications, recurrence, and operating time were analyzed. Laparoscopic hydrocelectomy was performed and the internal inguinal ring was closed with high ligation in children and iliopubic tract repair (IPTR) in adults. Results: Fifty-two pediatric (age 2-11 years) and 109 adult (age 21-51 years) female patients were included. More adult patients had inguinal pain (34.9%, 38/109) compared with children (3.8% 2/52) (P < .001). More EHCNs were located in the inguinal canal than protruding into the abdominal cavity in both groups. Regarding the fluid characteristics, hemorrhagic and inflammatory hydroceles were more common in adults than in children (P < .001). There were no serious complications, neither recurrence nor chronic pain was observed in either group except for a surgical-site hematoma in 1 adult patient. Conclusion: Laparoscopic hydrocelectomy together with additional age-appropriate procedures, including high ligation in children and IPTR in adults, is a safe and feasible method for treating EHCN.
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Affiliation(s)
- Sung Ryul Lee
- Department of Surgery, Damsoyu Hospital, Seoul, Republic of Korea
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Abstract
Canal of Nuck abnormality is a rare surgical condition. The pathologies are mostly encountered in young girls, less than five years of age. The incidence is even less in adults. Various pathologic conditions related to the failure of processus vaginalis obliteration can occur, involving herniation of intraabdominal structures including intestinal and genital contents such as the uterus, fallopian tube, and ovary and hydrocele of the canal of Nuck. According to its rarity, hydrocele of canal of Nuck is often misdiagnosed for common groin masses. This review summarizes and simplifies embryology, the pathophysiology of the canal of Nuck abnormalities, imaging findings, and treatment options with emphasis on the hydrocele.
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Wang L, Maejima T, Fukahori S, Shun K, Yoshikawa D, Kono T. Laparoscopic surgical treatment for hydrocele of canal of Nuck: A case report and literature review. Surg Case Rep 2021; 7:121. [PMID: 33983554 PMCID: PMC8119562 DOI: 10.1186/s40792-021-01205-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 05/10/2021] [Indexed: 12/19/2022] Open
Abstract
Background Hydrocele of canal of Nuck (HCN) is a rare disease in adult female. The diagnosis and treatment of HCN is still a challenge for surgeons. Case presentation A 56-year-old female presented with recent onset of occasional pain during exercise and an asymptomatic left groin swelling. Ultrasonography results were suspicious for left inguinal hernia incarceration and computed tomography (CT) scan showed no intestinal obstruction, which was considered as HCN. Laparoscopic hydrocelectomy of the HCN and a routine laparoscopic hernia repair via the transabdominal preperitoneal (TAPP) approach were performed. Postoperative pathology showed no malignant lesions or endometriosis. Conclusions The preoperative diagnosis of HCN is extremely important. Surgeons should choose appropriate surgical methods for different anatomical HCNs based on the preoperative diagnosis.
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Affiliation(s)
- Liming Wang
- Department of Surgery, Sapporo Higashi Tokushukai Hospital, 3-1, N-33, E-14, Higahi-ku, Sapporo, Hokkaido, 0650033, Japan.
| | - Taku Maejima
- Department of Surgery, Sapporo Higashi Tokushukai Hospital, 3-1, N-33, E-14, Higahi-ku, Sapporo, Hokkaido, 0650033, Japan
| | - Susumu Fukahori
- Department of Surgery, Sapporo Higashi Tokushukai Hospital, 3-1, N-33, E-14, Higahi-ku, Sapporo, Hokkaido, 0650033, Japan
| | - Katayose Shun
- Department of Surgery, Sapporo Higashi Tokushukai Hospital, 3-1, N-33, E-14, Higahi-ku, Sapporo, Hokkaido, 0650033, Japan
| | - Daitaro Yoshikawa
- Department of Surgery, Sapporo Higashi Tokushukai Hospital, 3-1, N-33, E-14, Higahi-ku, Sapporo, Hokkaido, 0650033, Japan
| | - Toru Kono
- Department of Surgery, Sapporo Higashi Tokushukai Hospital, 3-1, N-33, E-14, Higahi-ku, Sapporo, Hokkaido, 0650033, Japan
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Wang L, Maejima T, Fukahori S, Shun K, Yoshikawa D, Kono T. Laparoscopic assisted hydrocelectomy of the canal of Nuck: a case report. Surg Case Rep 2021; 7:52. [PMID: 33599854 PMCID: PMC7892654 DOI: 10.1186/s40792-021-01137-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 02/09/2021] [Indexed: 11/16/2022] Open
Abstract
Background Accurate diagnosis and complete resection of hydrocele of canal of Nuck (HCN) is still a challenge for surgeons. Case presentation A 28-year-old woman presented with a suspected inguinal hernia due to swelling in her right groin and was introduced for surgical treatment. Computed tomography scan revealed local cyst formation in the right groin and eliminated intestinal incarceration. In order to further confirm the diagnosis, we used laparoscopic exploration; after excluding a combined hernia, HCN was surgically removed using a conventional anterior peritoneal approach and a mesh patch repair was not needed. Postoperative pathology results showed no endometriosis or malignancy. Conclusions Laparoscopic assisted anterior approach provides both an accurate intraoperative diagnosis and a quick complete resection of HCN; it is the preferred treatment for women of childbearing age with pure HCN.
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Affiliation(s)
- Liming Wang
- Department of Surgery, Sapporo Higashi Tokushukai Hospital, 3-1, N-33, E-14, Higahi-ku, Sapporo, Hokkaido, 0650033, Japan.
| | - Taku Maejima
- Department of Surgery, Sapporo Higashi Tokushukai Hospital, 3-1, N-33, E-14, Higahi-ku, Sapporo, Hokkaido, 0650033, Japan
| | - Susumu Fukahori
- Department of Surgery, Sapporo Higashi Tokushukai Hospital, 3-1, N-33, E-14, Higahi-ku, Sapporo, Hokkaido, 0650033, Japan
| | - Katayose Shun
- Department of Surgery, Sapporo Higashi Tokushukai Hospital, 3-1, N-33, E-14, Higahi-ku, Sapporo, Hokkaido, 0650033, Japan
| | - Daitaro Yoshikawa
- Department of Surgery, Sapporo Higashi Tokushukai Hospital, 3-1, N-33, E-14, Higahi-ku, Sapporo, Hokkaido, 0650033, Japan
| | - Toru Kono
- Department of Surgery, Sapporo Higashi Tokushukai Hospital, 3-1, N-33, E-14, Higahi-ku, Sapporo, Hokkaido, 0650033, Japan
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Zhang W, Che X. Effect of indocyanine green fluorescence angiography on preventing anastomotic leakage after colorectal surgery: a meta-analysis. Surg Today 2021; 51:1415-1428. [PMID: 33428000 DOI: 10.1007/s00595-020-02195-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 10/07/2020] [Indexed: 12/12/2022]
Abstract
Anastomotic leakage (AL) is a serious but not uncommon complication after colorectal surgery. We conducted this study to evaluate the effect of routine indocyanine green fluorescence angiography (ICG-FA) on reducing the AL rate after colorectal surgery. We identified all research articles about colorectal surgery using ICG-FA, published in the PubMed, EMBASE, and Cochrane Library databases from the date of database establishment to May 2020. Revman 5.3 was used for statistical analysis. We analyzed 22 controlled studies and 7 non-controlled studies on ICG-FA, including 6312 patients. The controlled studies included 2354 patients in the ICG group and 3522 patients in the non-ICG group. Meta-analysis showed that ICG-FA reduced the AL rate after colorectal surgery significantly (RR = 0.39; 95% CI 0.30-0.50; P < 0.00001). However, patients whose resection line was changed based on the fluorescence angiography had a higher AL rate than those whose resection line was not changed (OR = 5.37; 95% CI 2.67-10.81; P < 0.00001). The overall complication rate, severe complication rate, and reoperation rate in the ICG group were significantly lower than those in the non-ICG group (RR = 0.79, 95% CI 0.67-0.92, P = 0.002; RR = 0.67, 95% CI 0.47-0.96, P = 0.03; RR = 0.53, 95% CI 0.29-0.96, P = 0.04, respectively), whereas the postoperative ileus rate was significantly higher in the ICG group than in the non-ICG group (RR = 1.65; 95% CI 1.09-2.50; P = 0.02), especially in Western countries (RR = 1.6; 95% CI 1.04-2.47; P = 0.03).ICG-FA may reduce the AL rate after colorectal surgery, but ICG-FA group patients with transection line change for insufficient blood perfusion to the anastomotic stoma after evaluation had a higher AL rate than those without transection line change. Therefore, ICG-FA can help to identify patients at high risk of AL and intercept its occurrence. Moreover, ICG-FA may reduce the overall complication rate, severe complication rate, and reoperation rate, but induce postoperative ileus. High-quality randomized-controlled trials with a placebo control are needed to further evaluate the effectiveness and safety of ICG-FA.
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Affiliation(s)
- Wei Zhang
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Xu Che
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China. .,Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, China.
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