Lateral Supravesical Hernia Successfully Treated With the Totally Extraperitoneal (TEP) Approach With Adjunctive Intra-abdominal Observation: A Case Report.

Abstract

Lateral supravesical hernias are an exceptionally rare subtype of external supravesical hernias that protrude laterally to the urinary bladder through the supravesical fossa. Due to their atypical location and nonspecific clinical presentation, they are often preoperatively misdiagnosed. We report the case of an 81-year-old male who presented with right lower quadrant discomfort and a reducible inguinal bulge. Preoperative CT revealed a hernia sac, but the precise anatomical origin was unclear. Laparoscopic observation, initially performed for a transabdominal preperitoneal (TAPP) approach, identified the hernia orifice lateral to the bladder, prompting a change in strategy to a totally extraperitoneal (TEP) repair to avoid bladder injury. The hernia was successfully reduced from the preperitoneal space, and mesh was placed without peritoneal violation. The postoperative course was uneventful, and the patient remained symptom-free with no recurrence at the 12-month follow-up. This report demonstrates that intra-abdominal observation can aid in the accurate diagnosis of atypical hernias and that a TEP approach offers a safe and effective treatment method, particularly when bladder proximity poses a surgical risk.