PMC6304920_01
Preoperative CT findings. (a) An axial slice showed a typical "Micky Mouse" shape (white arrow). (b) A coronal slice also revealed bilateral urinary bladder sliding into hernia orifices (white triangle).
CRIS2018-4904093.001.jpg
PMC6304920_01_CRIS2018-4904093.001.jpg
fig1
A CT scan revealed that his urinary bladder was herniating into the bilateral inguinal hernias with a typical "Mickey Mouse" shape (Figures 1(a) and 1(b)).
Trocar placements. Two 5 mm trocars were placed on the cranial side of the umbilicus (white rounds) compared to usual TAPP (black rounds).
CRIS2018-4904093.002.jpg
PMC6304920_01_CRIS2018-4904093.002.jpg
fig2
With the patient in the supine position under general anesthesia, we inserted three trocars as shown in Figure 2.
Surgical procedures. (a) The peritoneum was incised at the ventral side of the urinary bladder. (b) Hernia orifices were exposed by a bladder takedown approach (arrows). (c) A self-fixating mesh was also fixed with Cooper's ligament and rectus sheath. (d) The preperitoneal space was sutured and closed to screen the mesh.
CRIS2018-4904093.003.jpg
PMC6304920_01_CRIS2018-4904093.003.jpg
fig3
Then, we incised the peritoneum on the ventral side of the urinary bladder and took down the bladder to expose the hernia orifices (Figure 3(a)). Both hernia orifices were located inside of both medial umbilical folds; therefore, we intraoperatively diagnosed a recurrent bilateral supravesical bladder hernia with no lateral recurrences (Figure 3(b)). The mesh was fixed with Cooper's ligament and the rectus sheath by a mesh fixation device (AbsorbaTack , Medtronic Inc., Minneapolis, MN, USA) to keep it from slipping (Figure 3(c)). Finally, we sutured the urinary bladder with the ventral peritoneum to close the preperitoneal space and to screen the mesh using a barbed suture device (V-Loc  180, Medtronic Inc., Minneapolis, MN, USA) (Figure 3(d)).
Postoperative CT findings. A coronal slice revealed that appropriate repair for bilateral bladder sliding hernia was performed.
CRIS2018-4904093.004.jpg
PMC6304920_01_CRIS2018-4904093.004.jpg
fig4
A postoperative CT showed no recurrence of the bilateral supravesical bladder hernias (Figure 4).