Approximately 600,000 inguinal hernia repair operations are performed annually in the US of which, less than 20% are repaired using a laparoscopic approach. Transabdominal preperitoneal (TAPP) repair and totally extraperitoneal (TEP) repair are the most common used laparoscopic approaches. Although intraoperative complications are rare, the most commonly reported include: bowel and vascular injuries, insufficient exposure related to adhesions, bleeding, and bladder injury. We present a 32-year old man with complaints of chronic back and lower abdominal pain. He had a previous open inguinal hernia repair in his left side 10 years ago. On exam, he presents a tender, golf ball size defect in the right inguinal area. A TEP repair approach was elected, but got complicated with a bladder injury. This was managed with single layer closure and then converted to an open hernia repair without mesh. Intraperitoneal injuries can be repaired with absorbable sutures in multiple layers, while extraperitoneal injuries have been successfully treated with decompression alone. In cases of iatrogenic bladder injury, a single layer repair with a short period of decompression is appropriate. Because of the potential risk of mesh contamination, we elected for tissue repair. In conclusion, TEP is considered a technically difficult procedure, largely due to anatomic limitations and a demanding learning curve. Bladder injuries are a rare, yet challenging complication of laparoscopic inguinal hernia repairs often related to previous lower abdominal or pelvic surgery and blind balloon dissection. Minimally invasive techniques can effectively be used for bladder repair at the time of injury.