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Hernia From Infrainguinal Varicocelectomy
I had an infrainguinal varicocelectomy.  After the operation I essentially had continuous but low-level pain and swelling in the area under the site of the incision.  About a year later, the swelling and pain became more prominent but disappeared when I was lying down.  It was diagnosed as an inguinal hernia at the “deep orifice” [Secondary question: where exactly is this (the inguinal orifice: internal ring, external ring, back wall?  Indirect or direct inguinal hernia?)]  Incidentally, the swelling of the veins of the varicocele still occurred with valsaval.

I am 63 and have no history of hernias or any other related problems.  It is my understanding that a hernia is not possible with this technique because there is supposed to be no incision of fascia.  Primary question: I have been looking for an explanation about how the infrainguinal varicocelectomy could have led to the hernia.  A theoretical explanation would suffice.  Can you answer this question for me? There is a little more information from the operation report, below.

Varicocelectomy: There was an incision made in the low groin infrainguinal.  The dissection was carried down through Scarpa’s fascia ligating the superficial epigastrics between silk ties.  The dissection was carried further down until the cord was identified.  It was teased free of all of its attachments until the vascular structures and the vas were brought up to the surface with a Penrose drain.  A microscope was then pulled in and using right-angle jakes the veins were identified using the microscope and ligated using silk suture.  The wound was closed in two layers with vicryl and caprosyn.

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