Laparoscopic transabdominal preperitoneal repair for atypical inguinal hernia associated with adult anorchia: a case report.

Abstract

Adult anorchia complicated by inguinal hernia is rare, and its influence on intraoperative anatomy has been insufficiently described. We report a 54-year-old man with left inguinal hernia and congenital absence of testes who underwent laparoscopic transabdominal preperitoneal (TAPP) repair. Preoperative imaging demonstrated a lateral hernia orifice without identifiable spermatic cord structures. Laparoscopic findings revealed absence of normal vas deferens and testicular vessels, resulting in an indistinct internal inguinal ring and atypical inguinal anatomy. Standard anatomical landmarks used for hernia classification and dissection were not applicable, requiring careful preperitoneal dissection with attention to major vessels. TAPP repair enabled comprehensive visualization of the myopectineal orifice and safe mesh placement despite the anomalous anatomy. This case highlights that absence of spermatic cord structures can significantly alter inguinal anatomy and that laparoscopic repair is particularly valuable for both anatomical assessment and safe surgical management in such patients.