Postoperative lymphatic leakage following laparoscopic totally extraperitoneal inguinal hernia repair: the first case report and review of the literature.

purposePostoperative lymphatic leakage (PLL) is a rare and poorly understood complication following laparoscopic inguinal hernia repair (LIHR). While seroma is a well-documented postoperative finding, the potential for lymphatic leakage and subsequent lymphatic fistula is frequently overlooked and often misclassified. This report presents a unique case of postoperative lymphocele following Totally Extraperitoneal (TEP) inguinal hernia repair and discusses diagnostic considerations, management strategies, and implications for surgical practice.

methodsWe report the case of a 56-year-old male who developed a large, symptomatic inguinal lymphocele after undergoing TEP LIHR. Diagnosis was confirmed via magnetic resonance imaging (MRI) and analysis of the drained fluid. Management involved surgical drainage followed by low-dose radiotherapy. A narrative literature review was also performed to identify existing evidence on PLL following LIHR.

resultsThe patient developed a significant septated fluid collection (115 × 60 × 50 mm) compressing the bladder, consistent with a lymphocele. Drain output peaked at 350 mL/day. Fractionated low-dose radiotherapy (0.5 Gy × 10 sessions) led to a marked reduction in lymphatic output to <10 mL/day, permitting safe drain removal. At two-month follow-up, the patient remained asymptomatic. A narrative literature search revealed no previously reported cases of PLL following LIHR.

conclusionTo our knowledge, this is the first reported case of lymphocele and lymphatic fistula formation following TEP LIHR. This case highlights the need to recognize lymphatic leakage as a distinct complication. Low-dose radiotherapy appears to be an effective, minimally invasive treatment. Standardized terminology and further research are essential to improve diagnosis and management.