Laparoscopic repair of a ureter damaged during inguinal herniorrhaphy.

BACKGROUND

Laparotomy has been used generally to deal with ureteral injury. Recently, a few papers have reported the repair of gynecologic ureteral injuries by laparoscopy, with encouraging results; however, successful repair of a ureter damaged during an open inguinal herniorrhaphy fully performed by laparoscopy has not been reported yet.

PATIENT

A 49-year-old obese man (body mass index=35) in the 10 years before surgery began to note a protrusion in the scrotal region. The protrusion evolved asymptomatically for 8 years, and began to cause pain in the lumbar spine to the right and paresthesia of the right leg.

METHOD

An open right inguinal herniorrhaphy was performed. When the exeresis of the fatty tissue around the spermatic cord was being carried out, resection of a 12-cm tubular structure, supposedly the appendix, was performed. Wall defect was closed by a polypropylene mesh. Acute abdominal pain developed immediately in the postoperative period and investigation using laparoscopy was undertaken. After confirmation of ureteral injury, laparoscopic repair was performed, and the ureter was anastomosed without tension over a double-J catheter. A suction drain was left near the anastomosis.

RESULT

Postoperative period was uneventful. The vesical catheter was withdrawn on the eighth postoperative day and the drain on the twelfth postoperative day. The histopathologic report confirmed that the resected structure was the ureter. The patient has remained asymptomatic for 2 years since the surgery.