Your patient is young with such a large hernia so a repair would be what I would offer.  Under anaesthesia, these will more often than not reduce with minimal effort but if not then enlargement of the defect at the deep ring can be performed to facilitate reduction prior to a repair.  Obviously, I would not offer a laparoscopic repair in this case.  The other issue to address is why a young male has such a large hernia? He's had ot for 6 years so developed the hernia at 39.  It's grown significantly during that time so is there anything in his history to explain this- occupation, lifestyle and physical activity etc.  The other point to make is that the 'sac' doesn't have to be completely reduced, it is perfectly acceptable practice to divide the sac (and of course reduce the contents).

Thanks for the question,

I agree that this hernia needs to be fixed in such age group especially if the patient’s job demands physical activity for instance builders or farmers. In such big hernia would be very difficult to achieve complete dissection of the sac therefore the division of the sac would be the best option from my point of view. Finally it is important to address the risk factors for e.g. COPD, chronic smoking, etc... To decrease the chance of recurrence and post op complications.

Regards

here there are two issues

1. the hernia itself, which needs reduction. deep ring dilatation often helps in hernial content reduction.

2. as it is of long duration(6yrs) and huge, it needs to considered whether the hernial contents will have enough room within the abdominal cavity after reduction, without causing abdominal hypertension or abdominal compartment syndrome.

help from plastic surgeons may be needed. techniques like " component separation" may have to be done.

Thanks all of you for your valuable comments. Is it possible to reduce this huge hernia in staged procedure.? There will be increased intra abdominal pressure to a dangerous levels if we attempt reduction of all contents without initially increasing the abdominal