Journal article
Robot-Assisted Laparoscopic Repair of Extraperitoneal Ureteral Inguinal Hernia with Mesh Placement
Journal of endourology case reports, Vol.3(1), pp.97-100
2017
DOI: 10.1089/cren.2017.0046
PMCID: PMC5587904
PMID: 28894843
Abstract
Background:
Ureter involvement within indirect hernias is a rare phenomenon usually identified incidentally during herniorrhaphy. Even more rare are extraperitoneal ureteral inguinal hernias, which represent about 20% of these cases and are characterized by a substantial amount of extraperitoneal fat in the hernia defect, the absence of a peritoneal sac, and associated with hydroureteronephrosis and nephroptosis. To date, repair of ureteral inguinal hernias has been performed exclusively using open surgical techniques. We report the first case of successful robot-assisted laparoscopic repair of this rare presentation.
Case Presentation:
A morbidly obese 70-year-old male with an unremarkable surgical and urological history presents with a 15-year history of nonpainful, enlarging right scrotal swelling measuring 25 cm in diameter. CT imaging revealed right nephroptosis and a hernia defect containing a dilated right ureter looping into the scrotum surrounded by significant extraperitoneal fat. Retrograde pyelography and ureteral catheter placement confirmed a >100 cm ureter. The patient underwent a robot-assisted laparoscopic repair. The inferior epigastric artery, spermatic cord vessels, vas deferens, and ureter were identified. The defect was reduced using external scrotal pressure and reinforced with ProGrip™ self-fixating laparoscopic mesh. The patient was discharged 2 days later following an uneventful postoperative course.
Conclusion:
Although rare and usually incidentally discovered, extraperitoneal ureteral inguinal hernias can be identified preoperatively by the astute clinician. Preoperative identification allows for improved surgical planning, including a minimally invasive approach. Robot-assisted laparoscopic repair with mesh placement is a feasible alternative to traditional open techniques.
Details
- Title: Subtitle
- Robot-Assisted Laparoscopic Repair of Extraperitoneal Ureteral Inguinal Hernia with Mesh Placement
- Creators
- Daniel Pucheril - Henry Ford HospitalBrian Chun - Wayne State UniversityDeepansh Dalela - Henry Ford HospitalFiras Abdollah - Henry Ford HospitalScott A. Laker - Michigan Institute of UrologyCraig G. Rogers - Henry Ford Hospital
- Resource Type
- Journal article
- Publication Details
- Journal of endourology case reports, Vol.3(1), pp.97-100
- DOI
- 10.1089/cren.2017.0046
- PMID
- 28894843
- PMCID
- PMC5587904
- NLM abbreviation
- J Endourol Case Rep
- ISSN
- 2379-9889
- eISSN
- 2379-9889
- Publisher
- Mary Ann Liebert, Inc
- Number of pages
- 4
- Language
- English
- Date published
- 2017
- Academic Unit
- Urology
- Record Identifier
- 9984958309302771
Metrics
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