Testicular hydrocele postoperative laparoscopic inguinal hernia repair may be caused lymphatic leakage proved by indocyanine fluorescent dye: A case report

Abstract

Introduction and importanceIndocyanine green (ICG) fluorescent lymphography is reportedly a safe and effective method to diagnosis of lymphatic leakage. We report a case of a patient who underwent ICG fluorescent lymphography during laparoscopic inguinal hernia repair. Case presentationA 59-year-old man was referred to our department for the treatment of both inguinal hernias, during which laparoscopic ICG lymphography was performed. The patient had a history of open left inguinal indirect hernia repair at the age of 3 years. Following the induction of general anesthesia, 0.25 mg ICG was injected into both testicles, and the scrotum was gently massaged, after which laparoscopic inguinal hernia repair was performed. During the operation, ICG fluorescence was observed in two lymphatic vessels in the spermatic cord. The ICG fluorescent vessels were injured only on the left side due to strong adhesion between lymphatic vessels and the hernia sac, possibly due to a previous operation. ICG leakage was observed on the gauze. Laparoscopic inguinal hernia repair (transabdominal preperitoneal approach [TAPP]) was performed. The patient was discharged 1 day postoperatively. He had a slight postoperative ultrasonic hydrocele only in the left groin that was detected at the follow-up clinic 9 days postoperatively during ultrasonic examination (ultrasonic hydrocele). Clinical discussionWe report the use of ICG fluorescent lymphography during laparoscopic inguinal hernia repair in a patient who developed a postoperative ultrasonic hydrocele. ConclusionThis case may indicate a relationship between lymphatic vessel injury and hydroceles.