機器手臂輔助腹膜前修補治療膀胱疝合併復發性腹股溝疝：個案報告及文獻回顧

林瑞穎、吳俊德、劉冠麟、林政鋒、林承家、吳翊豪、陳鴻毅

基隆長庚醫院 外科部 泌尿科

Case report and literature review of Recurrent Right Inguinal Hernia with Urinary Bladder Herniation Treated by Robotic TAPP Repair

Jui-Ying Lin, Chun-Te Wu, Kuan-Lin Liu, Cheng-Feng Lin, Cheng-Chia Lin, Yi-Hao Wu, Hong-Yi Chen

Divisions of Urology, Department of Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan

Background:

Inguinoscrotal bladder hernia (ISH) represents an uncommon subtype of inguinal hernia, accounting for less than 4% of all cases and most frequently affecting elderly men with bladder outlet obstruction or benign prostatic hyperplasia (BPH) ^[1]. Because of its nonspecific presentation, ISH is often diagnosed intraoperatively. Minimally invasive techniques, particularly laparoscopic and robotic-assisted repairs, have revolutionized hernia surgery by reducing postoperative pain and facilitating faster recovery ^[2,3]. However, recurrent hernias remain a technical challenge, and management must be individualized based on prior repair type and anatomical complexity.

Case presentations:

A 67-year-old man with hypertension and diabetes mellitus presented with recurrent right inguinal swelling and intermittent syncope episodes, four years after a primary laparoscopic totally extraperitoneal (TEP) repair for a right direct inguinal hernia. Preoperative imaging revealed urinary bladder herniation through the recurrent defect. The patient underwent robot-assisted transabdominal preperitoneal (TAPP) repair and simultaneous Rezum water vapor therapy for BPH-related urinary retention. The postoperative course was uneventful except for a transient urinary tract infection caused by Pseudomonas aeruginosa and Klebsiella pneumoniae, which resolved with antibiotic therapy.

Discussion:

Recurrent hernia following laparoscopic repair is multifactorial, with major causes including insufficient mesh coverage, patch contraction, or inadequate fixation ^[4,5]. Compared with open Lichtenstein repair, laparoscopic and robotic TAPP approaches provide improved visualization and reduced postoperative pain, with comparable recurrence rates ^[6,7]. Robotic assistance further enhances precision, ergonomics, and safety in complex or recurrent cases, particularly when visceral structures such as the bladder are involved ^[8,9].

Conclusion:

This case highlights the feasibility and safety of robotic TAPP repair for managing recurrent inguinal hernia complicated by urinary bladder herniation. The robotic platform enables precise dissection and optimal mesh placement while minimizing the risk of organ injury. In elderly men with BPH or voiding-related groin symptoms, preoperative imaging—preferably contrast-enhanced CT—should be considered to identify possible bladder involvement