Laparoscopic Intraperitoneal Onlay Mesh Plus Repair of a Hernia Adjacent to a Vesicocutaneous Urinary Diversion: A...

Hernias occurring adjacent to a urinary diversion are extremely rare, and their classification and optimal surgical management have not yet been established.

A 76-year-old man presented with a hernia adjacent to a vesicocutaneous urinary diversion after undergoing laparoscopic abdominoperineal resection for rectal cancer combined with robot-assisted radical prostatectomy, resulting in sigmoid colostomy and vesicocutaneous fistula formation. Laparoscopic repair was performed using the intraperitoneal onlay mesh (IPOM) plus technique. After primary fascial closure, a trimmed composite mesh was placed with adequate overlap and fixed using a modified fixation strategy combining non-absorbable tacks and absorbable sutures. Tacking was deliberately avoided in the anatomically hazardous region adjacent to the external iliac vessels, and fixation in this area was achieved using superficial sutures only. The postoperative course was uneventful, with no recurrence or mesh-related complications during the 18-month follow-up.

Laparoscopic IPOM plus repair may be a feasible option for hernias adjacent to a vesicocutaneous urinary diversion when primary fascial closure and safe mesh fixation can be achieved with careful consideration of pelvic anatomy and adjacent neurovascular structures. However, further accumulation of cases and long-term follow-up are required to establish its safety.