Incidental finding of a congenital unilateral absence of the vas deferens during robotic inguinal hernia repair: missing a crucial landmark. A case report

Abstract

Introduction

We report on a case of congenital unilateral atresia of the vas deferens encountered during a robotic-assisted transabdominal preperitoneal (TAPP) inguinal hernia repair.

Case report

Our 65-years-old male patient was scheduled for a bilateral robotic-assisted TAPP inguinal hernia repair because of bilateral symptomatic groin hernia. Standard intraoperative dissection obtaining a critical view of the myopectineal orifice did not allow for an identification of the vas deferens (VD) on the left side. On the right side, a normal VD was identified. There was no suspicion of an intraoperative lesion or ligation of the VD. Both gonadal and inferior epigastric vessels were present on both sides. Upon clinical evaluation, no VD was palpable in the scrotum on the left side. The diagnosis of a congenital unilateral absence of the vas deferens was made. Additional abdominal computed tomography scan revealed a congenital agenesis of the left kidney, ureter, vesicula seminalis and vas deferens.

Discussion

The accidental finding of a congenital absence of the vas deferens during inguinal hernia repair is rare. However, surgeons performing inguinal hernia repair should be aware of this condition and the clinical implications it poses, as this could prevent unnecessary exploration and missed diagnosis of associated underlying conditions.

Keywords:

• Congenital unilateral absence of the vas deferens
• renal agenesis
• robotic surgery
• Inguinal hernia repair
• case report

Acknowledgements

This case was presented at RAWS 2021.

Disclosure statement

No potential conflict of interest was reported by the author(s). K. Pauwaert and M. Dewulf have no conflicts of interest or financial ties to disclose.

Additional information

Funding

F. Muysoms reports having received research grants from Intuitive, Medtronic, Dynamesh, and received speakers honorarium from Medtronic, Bard-Davol, Dynamesh, Intuitive and received consultancy fees from Medtronic, Intuitive, CMR Surgical.