LAPAROSCOPIC TRANSABDOMINAL PREPERITONEAL REPAIR OF LEFT SUPRAVESICAL HERNIA: A DETAILED CASE REPORT AND REVIEW OF LITERATURE

Abstract

Background: Supravesical hernia is a rare subtype of pelvic hernia occurring through a defect in the supravesical fossa, bordered by the medial and median umbilical ligaments above the urinary bladder. These hernias account for less than 4% of all hernias and often pose a diagnostic challenge due to their nonspecific clinical presentation, ranging from asymptomatic groin swelling to bowel obstruction or urinary disturbances.

Case Presentation: We present a case of a 49-year-old male with a two-year history of left groin swelling and intermittent episodes of upper abdominal discomfort. Physical examination revealed a 5*4 cm globular swelling in the left groin, extending to the root of the scrotum, reducible, with a positive cough impulse and smooth surface. Ultrasonography revealed a 1 cm defect in the left inguinal region with bladder herniation. The patient underwent successful laparoscopic transabdominal preperitoneal (TAPP) repair under general anesthesia. Intraoperative findings included two direct hernias on the left side with the urinary bladder as the hernia content. A composite mesh was placed and secured with tackers. Postoperative recovery was uneventful, and the patient was discharged with significant symptomatic improvement.

Discussion: Supravesical hernias are classified as internal or external based on their anatomical location. They may involve the bladder, leading to urinary symptoms or complications. Early diagnosis is essential, and imaging studies such as ultrasonography and computed tomography (CT) play a vital role. The TAPP approach offers advantages such as superior visualisation, precise dissection, and effective mesh placement.

Conclusion: This case underscores the importance of considering supravesical hernias in the differential diagnosis of groin swelling and demonstrates the efficacy of laparoscopic TAPP repair in managing such cases. Early surgical intervention is crucial to prevent complications.