In 1691, Dutch anatomist Anton Nuck first described HCN, which manifested as groin pain and compressible or incompressible local swelling of the labia [10, 11]. Unclosed HCN can cause asymptomatic effusion or hernia resulting in protrusion of abdominal organs, most commonly the intestine and ovaries . This can lead to emergent situations such as strangulation obstruction of the intestine or torsion of the ovary. Additionally, part of the HCN may contain endometrial tissue, causing periodic swelling during menstruation [3, 12]. Due to these potential complications, timely diagnosis and prompt treatment of HCN is critical .
Imaging, especially ultrasound (US), is helpful for timely diagnosis; Doppler ultrasound can confirm intestinal obstruction and ischemic necrosis . It has been reported that CT scan or magnetic resonance imaging can more effectively observe the anatomy around the cyst and determine whether the cyst communicated with the abdominal cavity . Even so, in some cases, the final diagnosis depends on the intraoperative findings [4, 5]. Compared with the traditional anterior approach, the pneumoperitoneum in laparoscopic surgery will increase intra-abdominal pressure. Laparoscopy may be the best tool for diagnosing potential weak areas of the inner ring of the groin and can rule out the incarceration of internal organs in the abdominal cavity [13,14,15].
With the development of laparoscopy in recent years, there are related reports of laparoscopic removal of HCN, but HCN patients with indirect inguinal hernia can actively consider laparoscopic surgery [7, 16]. The inguinal hernia can be repaired at the same time. However, if it is only a simple HCN, laparoscopic removal of HCN will definitely lead to enlargement of the inner ring and a patch must be placed for repair .
For adult women of childbearing age, whether the patient has HCN combined with inguinal hernia, or the patient intends to be pregnant in the future [11, 14]. In addition, during laparoscopic HCN resection, it is difficult to successfully free the distal end of HCN because of the obstructed view of the deep inguinal canal and the inferior epigastric vessels [6, 7]. At this time, once laparoscopy finds that the patient has a pure HCN, the simplest anterior resection without hesitation may shorten the operation time .
Therefore, for the diagnosis and treatment of HNC, surgeons need to choose the best method according to the woman’s age, whether the patient has HCN combined with inguinal hernia, or the patient intends to be pregnant in the future. Laparoscopic combined with anterior approach undoubtedly provides the most accurate diagnostic method and the most rapid treatment for treatment of pure HCN. It may be considered as the preferred treatment method for young women of childbearing age without complicated hernia.