In modern surgical practice, minimally invasive techniques have transformed the way complex abdominal and groin conditions are managed. One such innovative approach is the laparoscopic orchiectomy combined with hernia repair. This dual procedure is particularly beneficial for patients presenting with both a diseased or non-functioning testis and an associated inguinal hernia. By addressing both conditions simultaneously through laparoscopy, surgeons can minimize operative trauma, reduce hospital stay, and enhance patient recovery.

Understanding Orchiectomy and Hernia Repair

Orchiectomy is the surgical removal of one or both testicles. It may be indicated for a variety of conditions, including testicular tumors, severe atrophy, chronic infection, trauma, or as part of gender-affirming surgery.

Inguinal hernia repair involves the correction of a protrusion of abdominal contents through a weakened area in the inguinal canal. Hernias can cause pain, swelling, and risk of complications such as strangulation if left untreated.

When a patient presents with both a non-viable or diseased testis and an inguinal hernia on the same side, it is both logical and efficient to combine the two surgeries into a single laparoscopic procedure.

Indications for Combined Surgery

This dual approach may be considered in the following scenarios:

Presence of testicular malignancy requiring orchiectomy along with co-existing inguinal hernia.

Severe testicular atrophy or necrosis due to torsion, infection, or trauma with associated hernia.

Inguinal hernia where the testis itself is compromised or non-functioning.

Elderly patients with long-standing hernias and testicular pathology.

Patients undergoing orchiectomy for benign conditions where hernia repair is also required.

Advantages of Laparoscopic Approach

Performing orchiectomy and hernia repair laparoscopically offers multiple benefits compared to open surgery:

Single anesthesia session: Both conditions are treated simultaneously.

Smaller incisions: Reduced postoperative pain and better cosmetic outcomes.

Shorter hospital stay: Patients are often discharged within 24–48 hours.

Faster recovery: Early return to daily activities.

Comprehensive treatment: Minimizes recurrence of hernia while eliminating diseased testis.

Lower complication rates: Less tissue trauma and fewer wound-related problems.

Surgical Technique

Patient Preparation: The patient is placed under general anesthesia in the supine position. Standard preoperative evaluation and imaging help in planning the approach.

Port Placement: Pneumoperitoneum is established, and laparoscopic ports are introduced—usually one umbilical port for the camera and two additional working ports in the lower abdomen.

Orchiectomy Step:

The spermatic cord structures are identified laparoscopically.

The testicular vessels and vas deferens are clipped or sealed using advanced energy devices.

The testis is removed, often through an endoscopic retrieval bag to avoid contamination.

Hernia Repair Step:

The hernia sac is carefully dissected and reduced back into the abdominal cavity.

The inguinal defect is identified, and a prosthetic mesh is placed to reinforce the posterior wall of the inguinal canal.

The mesh is fixed using tackers or glue, depending on surgeon preference, ensuring tension-free repair.

Completion: The operative field is inspected for hemostasis, ports are withdrawn, and incisions are closed.

This procedure can be performed using transabdominal preperitoneal (TAPP) or totally extraperitoneal (TEP) approaches for the hernia repair, depending on the surgeon’s expertise.

Postoperative Care

Recovery after laparoscopic orchiectomy with hernia repair is generally smooth. Key aspects of postoperative care include:

Pain management: Oral analgesics are usually sufficient.

Early mobilization: Encouraged within hours of surgery to reduce risks of venous thrombosis.

Diet: Patients resume liquids on the same day, advancing to solids as tolerated.

Wound care: Minimal due to small incisions, reducing the risk of infection.

Follow-up: Monitoring for testicular pathology results (if malignancy suspected) and ensuring hernia repair integrity.

Most patients can return to normal, non-strenuous activities within one to two weeks and resume full physical activity after four to six weeks.

Risks and Complications

Although safe and effective, the procedure carries potential risks, including:

Bleeding or hematoma formation.

Infection at incision or mesh site.

Injury to nearby structures such as bladder or blood vessels.

Chronic groin pain in rare cases after hernia repair.

Hernia recurrence if mesh placement is inadequate.

Psychological impact of orchiectomy, requiring counseling in some patients.

With careful technique and patient selection, complication rates are very low, and outcomes are highly favorable.

Long-Term Outcomes

Laparoscopic orchiectomy combined with hernia repair offers excellent long-term results. Hernia recurrence rates are minimal with proper mesh placement, and removal of the diseased testis eliminates the risk of further complications from that organ. Patients report high satisfaction due to shorter recovery times, less pain, and improved cosmetic results compared to open surgery. In cases of malignancy, combining orchiectomy with hernia repair avoids the need for two separate surgeries, thereby streamlining treatment.

Conclusion

Laparoscopic orchiectomy combined with hernia repair is a safe, efficient, and patient-friendly surgical solution for individuals requiring treatment for both testicular pathology and inguinal hernia. By addressing both problems simultaneously, this minimally invasive approach reduces operative burden, enhances recovery, and ensures durable outcomes. With advances in laparoscopic techniques and expertise, this combined procedure exemplifies the future of comprehensive surgical care—maximizing benefits while minimizing risks.