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.