Laparoscopic Bladder Injury Repair during Total Extraperitoneal Hernia Surgery: Description of the Technique and Review of Literature

Jakub Wilhelm, MD, Garrett Keim, MSIII, Alexey Markelov, MD, Artun Aksade, MD, FACS

Easton Hospital, Drexel University College of Medicine

Bladder injury from laparoscopic hernia repair is a well described, but rare complication with an incidence of less than 0.5%. Only three cases of laparoscopic repair of extraperitoneal bladder injuries are reported in English language medical literature. We present a case of a 52 year old male who underwent elective bilateral laparoscopic total extraperitoneal inguinal hernia repair which was complicated by bladder injury during balloon dissection of the preperitoneal space. The injury was diagnosed intraoperatively and due to extraperitoneal location of the injury, decision was made to proceed with primary repair. A primary laparoscopic repair of the bladder, using endostitch was then preformed. The hernia repair was then completed using mesh. The patient had an uneventful recovery and follow-up cystogram showed absence of urinary leak. In this case report, we provide a comprehensive literature review regarding bladder injuries during laparoscopic hernia repair. We also provide description of the technique that was utilized for bladder repair. Although there is lack of prospective studies, this case can serve as limited evidence that extraperitoneal bladder injuries recognized intraoperatively can be safely repaired laparoscopically.

Session: Poster Presentation

Program Number: P273