Case report

A 71-year-old man was referred to our surgical outpatient clinic because of bilateral symptomatic inguinal hernias. He had a relevant medical history of chronic obstructive pulmonary disease for over 20 years, a laparoscopic cholecystectomy because of symptomatic cholelithiasis 15 years earlier, idiopathic recurrent deep vein thrombosis in both legs and pulmonary embolism 10 months earlier, and right-sided epididymitis which was treated conservatively 5 months before. He had no known allergies and used Acenocoumarol (3 mg daily) and Salbutamol (200 mcg inhalations, 4 daily). Physical examination revealed left- and right-sided inguinal hernias which were easily reducible without symptoms of incarceration. His scrotum and testes were normal. Palpation of the vasa deferentia was not performed. We planned an elective laparoscopic TEP repair of both inguinal hernias and advised discontinuation of the Acenocoumarol 24 hours before surgery with bridging therapy (Dalteparin 25,000 IE/mL, 0.3 mL twice daily).
We performed a laparoscopic TEP repair of both inguinal hernias, which were found to be direct types, under general anaesthesia using a conventional three-port technique. Intra-operatively we observed left-sided absence of the vas deferens. Normal inferior epigastric vessels and testicular vessels were found bilaterally. Iatrogenic damage was not observed nor suspected. The procedure and post-operative recovery were uneventful.
Postoperative ultrasonography revealed a normal bladder, prostate, and right-sided kidney and ureter, but absence of the left-sided kidney and ureter. A nephrologist was consulted, but since the patient was asymptomatic, normotensive, and had normal levels of serum creatinine and urinary protein, no further management was advised besides annual surveillance and recommendations regarding cardiovascular disease prevention.