Objective To investigate the application value of double-ligation strategy for hernia sac management in the treatment of scrotal hernia with liver cirrhosis and ascites.

Methods The retrospective and descriptive study was conducted. The clinical data of 31 male patients with cirrhotic ascites and scrotal hernia who were admitted to Beijing Chao‑Yang Hospital, Capital Medical University from January 2023 to December 2024 were collected. They were aged (63±12) years. All patients underwent Lichtenstein tension‑free hernia repair under local anesthesia with the hernia sac management strategy of selective fenestration decompression, proximal double ligation, and flexible distal management. Observation indicators: (1) surgical and postoperative conditions; (2) follow‑up. Measurement data with normal distribution were represented as Mean±SD. Measurement data with skewed distribution were represented as M(Q₁,Q₃) or M(range). Count data were expressed as absolute numbers.

Results (1) Surgical and postoperative conditions: all the 31 patients under-went Lichtenstein repair successfully under local anesthesia, without conversion to other anesthesia or surgical approaches. The operation time of 31 patients was 55(50,60) minutes, volume of intra-operative blood loss was 5(3, 5) mL, duration of postoperative hospital stay was 2(1,3) days, and maximum hernia ring diameter was 3(3, 3) cm. Synthetic and biologic meshes were used in 20 and 11 patients, respectively. Intraoperative fenestration decompression was performed in 6 patients. Distal sac management included complete resection in 9 patients and abandonment with fenestration in 22 patients. Postoperative complications occurred in 4 of 31 patients, including incisional hematoma in 1 case and scrotal swelling in 3 cases, which were all classified as Clavien‑Dindo grade Ⅰ. All complications were resolved with conservative treatment. No incisional infection, mesh infection, ascites leakage, ischemic orchitis, testicular atrophy, or chronic pain was observed. No perioperative mortality occurred. (2) Follow‑up: all 31 patients were followed up for 21(17,27) months. Of the 31 patients, 1 case experienced recurrence at 6 months postoperatively. This patient underwent repair with synthetic mesh, but postoperative ascites was poorly controlled. Open reoperation was performed at 12 months postoperatively, and no recurrence was observed up to the last follow‑up. Nine patients died due to liver disease progression, with causes including hepatic failure, gastrointes-tinal bleeding, and hepatic carcinoma. All deaths occurred beyond 18 months (range, 13-27 months).

Conclusion For patients with cirrhotic ascites and scrotal hernia, the hernia sac management strategy of selective fenestration decompression, proximal double ligation, and flexible distal manage-ment is feasible, with favorable short‑term outcomes.