Vesicocutaneous fistula following laparoscopic transabdominal pre-peritoneal inguinal hernia repair: An unusual complication – A case report

ABSTRACT: Vesicocutaneous fistula (VCF) represents an extremely rare complication following laparoscopic transabdominal pre-peritoneal (TAPP) inguinal hernia repair, with fewer than twenty cases documented worldwide. We report a 46-year-old diabetic male who developed VCF 12 months after laparoscopic TAPP repair for left inguinal pantaloon hernia. The patient presented with malodorous watery discharge during micturition from a cutaneous opening in the left inguinal region. Magnetic resonance imaging demonstrated a fistulous tract connecting the anterior bladder wall to the overlying skin. Cystoscopy confirmed mesh erosion into the bladder with an internal opening on the anterior wall. Surgical management included complete fistulectomy, mesh removal and two-layer bladder repair reinforced with omental patch. Complete fistula healing was achieved at 3 months with no recurrence of either the fistula or hernia. This case demonstrates that VCF can occur despite technically adequate TAPP repair and emphasises the need for high clinical suspicion when patients present with delayed inguinal symptoms, particularly in diabetic patients.