Laparoscopic repair of a supravesical hernia presenting as a ‘recurrent’ inguinal hernia in a 5-year-old female

Abstract

A 5‐year‐old female presented with a clinical recurrence of her left inguinal hernia, having undergone a herniotomy 4 days prior. She was clinically well, with a soft non‐tender abdomen and a reducible inguinal mass.

Her original operation had been performed via a standard groin crease incision. A patent processus vaginalis was isolated and transfixed with an absorbable braided suture at the left internal inguinal ring. The external oblique aponeurosis was closed with the same suture. No other defects were noted.

Given the unusual time frame of recurrence, laparoscopy was performed. Omentum was seen passing through a hernial defect of the anterior abdominal wall, between the lateral edge of the bladder and the medial umbilical ligament (obliterated superior vesical artery; Fig. 1a). The hernia sac then exited through the superficial inguinal ring, following the path of least resistance through the anterior abdominal wall. This is an external supravesical hernia. A laparoscopic repair was performed, using the technique previously described by Zallen and Glick.1 The omentum was reduced (Fig. 1b), the hernia sac everted (Fig. 1c) and double‐endoloop ligated, with excision of the redundant sac (Fig. 1d). There has been no recurrence on follow‐up.