Laparoscopic Bilateral Gonadectomy and Inguinal Hernia Repair with Mesh for Complete Androgen Insensitivity Syndrome: A Case Report.

BACKGROUND: Complete androgen insensitivity (CAIS) is a difference of sex development, in which there is complete androgen receptor resistance, leading to a female phenotype, despite the presence of normal testes. There is a recognized risk of testicular germ cell tumor in adulthood as high as 15%, and gonadectomy is usually performed in late adolescence or early adulthood.

CASE: A 20-year-old patient, with a known diagnosis of CAIS since the age of 16, underwent magnetic resonance imaging of the pelvis, which revealed the testes lying deep into the inguinal canal. The patient was explored laparoscopically and using the technique of transabdominal preperitoneal hernia repair both testes were successfully reduced into the peritoneal cavity and resected. In addition, the defect of the internal inguinal ring was covered and reinforced using a prosthetic polypropylene mesh.

SUMMARY AND CONCLUSION: Minimally invasive gonadectomy is feasible even for gonads situated deep into the inguinal canal. Established benefits of laparoscopic surgery such as reduced postoperative pain, rapid recovery, aesthetically small incisions, and early return to normal activities are very important for CAIS patients. Multidisciplinary team work, among gynecologists and general surgeons, provides excellent results in these complex cases.