LAPAROSCOPIC APPROACH TO INGUINAL BLADDER HERNIA

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Abstract Background To present an infrequent case of inguinal bladder hernia (IBH) in an adult patient, as well as its minimally invasive approach. Method A 67-year-old obese male patient, with a medical history of bilateral hernioplasty by open approach, presented a history of lower urinary tract symptoms, urgency urinary incontinence and recurrent urinary tract infections of months of evolution. The clinical examination revealed a left inguinoscrotal hernia that was irreducible to palpation. Renal function was normal and Prostate Specific Antigen (PSA) level was 1.19 ng/ml. Ultrasonography showed no significative prostatic hypertrophy or hydronephrosis. Cystoscopy and cystography revealed a left IBH and suspected a bladder diverticulum associated. Computed tomography dismissed ureteral involvement. Results A scheduled surgery was decided. Surgical exploration found a direct left inguinal hernia containing almost ¾ parts of the bladder. No bladder diverticulum was observed. The next step was hernia reduction, which involved some technical difficulties. Hernia repair was performed by laparoscopic trans-abdominal pre-peritoneal hernioplasty (TAPP). Polyvinylidene fluoride (PDVF) mesh was used and fixed with non-absorbable tackers. The bladder integrity was confirmed with the instillation of saline solution through a urinary catheter. The patient was discharged without complications on the first postoperative day. Conclusion Inguinal bladder hernias are an uncommon condition that can often be difficult to diagnose. Furthermore, they constitute a surgical challenge since iatrogenic injuries and complications are possible. Perioperative imaging can help to make a diagnosis with certainty and to prevent misleading. The treatment of this pathology can be safely performed through laparoscopic approach and with less comorbidities than open surgery.

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