Background: Laparoscopic inguinal hernia repair is widely favored for its low recurrence rates and faster recovery. However, rare complications such as bladder injuries and vesico-cutaneous fistulas (VCF) may occur, often due to mesh-related erosion. Aim: This report illustrates a rare case of VCF following totally extraperitoneal (TEP) hernia repair, emphasizing diagnostic challenges, surgical decision-making, and outcomes. Case Presentation: A 70-year-old male underwent laparoscopic TEP right inguinal hernia repair. Three years later, he presented with haematuria and recurrent right groin abscesses at the site of the original repair. Despite multiple hospital visits and image-guided drainage, the underlying diagnosis was delayed. Retrospective correlation with his prior surgical history could have prompted earlier consideration of mesh-related complications. Imaging eventually revealed chronic mesh infection, and operative removal was performed. A persistent wound led to cystographic confirmation of a vesico-cutaneous fistula tracking from the right bladder base to the suprapubic wound. The patient was ultimately managed conservatively with catheterization and wound care, achieving spontaneous fistula closure without surgical repair. Conclusion: This case underscores the importance of recognizing vesico-cutaneous fistula as a delayed complication of mesh-based hernia repair. Early diagnosis and surgical removal of infected mesh are critical and may significantly reduce repeated hospital presentations, prolonged patient discomfort, and unnecessary admissions. Prompt urological referral and multidisciplinary team (MDT) involvement can streamline management and improve outcomes. In this case, simple catheterization alone led to complete fistula healing.
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