1
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Jallali M, Chaouch MA, Zenati H, Hassine HB, Gafsi B, Noomen F. Complications unveiled: A detailed case report on mesh migration post-incisional hernia repair. Int J Surg Case Rep 2024; 121:109976. [PMID: 38954968 DOI: 10.1016/j.ijscr.2024.109976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 06/24/2024] [Accepted: 06/27/2024] [Indexed: 07/04/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Repairing incisional abdominal wall hernia with nonabsorbable meshes is one of the most common procedures in general surgery. Mesh migration into the intestine is rare but a serious complication. It can occur months or even years after surgery and often presents with vague abdominal pain, making diagnosis tricky. CASE PRESENTATION We report a rare case of a 52-year-old female presenting a small bowel obstruction secondary to mesh migration from the abdominal wall into the intestine, 10 years after repeated surgical repair of a ventral incisional hernia. At surgery, a mesh was migrated into a small bowl. The patient had a small bowel resection. The postoperative course was simple and the patient was discharged after 5 days. CASE DISCUSSION Incisional hernia repair with mesh is one of the most commonly performed surgical procedures worldwide. Many complications have been linked to the use of mesh; among the most frequently reported are seromas, hematomas, and infections. Mesh migration remains an uncommon event after incisional hernia repair, and even rarer when considering complete migration within the intestinal lumen. The exact cause of this complication remains unknown. Multiple hypotheses have been proposed for mesh migration. Abdominal pain, intermittent or persistent intestinal obstruction, mass formation, and viscus perforation represent the most common clinical manifestation. Total removal of the mesh via laparoscopy or laparotomy is recommended, along with either partial or entire resection of the organ. CONCLUSION Mesh migration is a an uncommon possible complication in case of incisional hernia mesh repair and it requires often surgical intervention.
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Affiliation(s)
- Maissa Jallali
- Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia
| | - Mohamed Ali Chaouch
- Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia.
| | - Hanen Zenati
- Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia
| | - Hiba Ben Hassine
- Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia
| | - Besma Gafsi
- Department of Anesthesia, Monastir University Hospital, Monastir, Tunisia
| | - Faouzi Noomen
- Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia
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2
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Kirkpatrick AW, Coccolini F, Tolonen M, Minor S, Catena F, Celotti A, Gois E, Perrone G, Novelli G, Garulli G, Ioannidis O, Sugrue M, De Simone B, Tartaglia D, Lampella H, Ferreira F, Ansaloni L, Parry NG, Colak E, Podda M, Noceroni L, Vallicelli C, Rezende-Netos J, Ball CG, McKee J, Moore EE, Mather J. Are Surgeons Going to Be Left Holding the Bag? Incisional Hernia Repair and Intra-Peritoneal Non-Absorbable Mesh Implant Complications. J Clin Med 2024; 13:1005. [PMID: 38398318 PMCID: PMC10889414 DOI: 10.3390/jcm13041005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 01/29/2024] [Accepted: 01/31/2024] [Indexed: 02/25/2024] Open
Abstract
Ventral incisional hernias are common indications for elective repair and frequently complicated by recurrence. Surgical meshes, which may be synthetic, bio-synthetic, or biological, decrease recurrence and, resultingly, their use has become standard. While most patients are greatly benefited, mesh represents a permanently implanted foreign body. Mesh may be implanted within the intra-peritoneal, preperitoneal, retrorectus, inlay, or onlay anatomic positions. Meshes may be associated with complications that may be early or late and range from minor to severe. Long-term complications with intra-peritoneal synthetic mesh (IPSM) in apposition to the viscera are particularly at risk for adhesions and potential enteric fistula formation. The overall rate of such complications is difficult to appreciate due to poor long-term follow-up data, although it behooves surgeons to understand these risks as they are the ones who implant these devices. All surgeons need to be aware that meshes are commercial devices that are delivered into their operating room without scientific evidence of efficacy or even safety due to the unique regulatory practices that distinguish medical devices from medications. Thus, surgeons must continue to advocate for more stringent oversight and improved scientific evaluation to serve our patients properly and protect the patient-surgeon relationship as the only rationale long-term strategy to avoid ongoing complications.
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Affiliation(s)
- Andrew W. Kirkpatrick
- Regional Trauma Services, Department of Surgery, Critical Care Medicine, University of Calgary, Calgary, AB T2N 2T9, Canada
- TeleMentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group, University of Calgary, Calgary, AB T3H 3W8, Canada
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, 56124 Pisa, Italy;
| | - Matti Tolonen
- Emergency Surgery Department, HUS Helsinki University Hospital, 00029 Helsinki, Finland;
| | - Samual Minor
- Department of Surgery and Critical Care Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada;
| | - Fausto Catena
- Head Emergency and General Surgery Department, Bufalini Hospital, 47521 Cesena, Italy; (F.C.); (C.V.)
| | | | - Emanuel Gois
- Department of Surgery, Londrina State University, Londrina 86038-350, Brazil;
| | - Gennaro Perrone
- Department of Emergency Surgery, Parma University Hospital, 43125 Parma, Italy;
| | - Giuseppe Novelli
- Chiurgia Generale e d’Urgenza, Osepedale Buffalini Hospital, 47521 Cesna, Italy;
| | | | - Orestis Ioannidis
- 4th Department of Surgery, Medical School, Aristotle University of Thessaloniki, General Hospital “George Papanikolaou”, 57010 Thessaloniki, Greece;
| | - Michael Sugrue
- Letterkenny University Hospital, F92 AE81 Donegal, Ireland;
| | - Belinda De Simone
- Unit of Emergency Minimally Invasive Surgery, Academic Hospital of Villeneuve-Saint-Georges, 91560 Villeneuve-Saint-Georges, France;
| | - Dario Tartaglia
- Emergency and General Surgery Unit, New Santa Chiara Hospital, University of Pisa, 56126 Pisa, Italy;
| | - Hanna Lampella
- Gastrointestinal Surgery Unit, Helsinki University Hospital, Helsinki University, 00100 Helsinki, Finland;
| | - Fernando Ferreira
- GI Surgery and Complex Abdominal Wall Unit, Hospital CUF Porto, Faculty of Medicine of the Oporto University, 4200-319 Porto, Portugal;
| | - Luca Ansaloni
- San Matteo Hospital of Pavia, University of Pavia, 27100 Pavia, Italy;
| | - Neil G. Parry
- Department of Surgery and Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 3K7, Canada;
| | - Elif Colak
- Samsun Training and Research Hospital, University of Samsun, 55000 Samsun, Turkey;
| | - Mauro Podda
- Department of Surgical Science, University of Cagliari, 09124 Cagliari, Italy;
| | - Luigi Noceroni
- Hospital Infermi Rimini, 47923 Rimini, Italy; (G.G.); (L.N.)
| | - Carlo Vallicelli
- Head Emergency and General Surgery Department, Bufalini Hospital, 47521 Cesena, Italy; (F.C.); (C.V.)
| | - Joao Rezende-Netos
- Trauma and Acute Care Surgery, General Surgery, St. Michael’s Hospital, University of Toronto, Toronto, ON M5T 1P8, Canada;
| | - Chad G. Ball
- Acute Care, and Hepatobiliary Surgery and Regional Trauma Services, University of Calgary, Calgary, AB T2N 1N4, Canada; (C.G.B.); (J.M.)
| | - Jessica McKee
- TeleMentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group, University of Calgary, Calgary, AB T3H 3W8, Canada
| | - Ernest E. Moore
- Ernest E Moore Shock Trauma Center at Denver Health, Denver, CO 80204, USA;
| | - Jack Mather
- Acute Care, and Hepatobiliary Surgery and Regional Trauma Services, University of Calgary, Calgary, AB T2N 1N4, Canada; (C.G.B.); (J.M.)
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3
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Zhang Y, Lin H, Liu JM, Wang X, Cui YF, Lu ZY. Mesh erosion into the colon following repair of parastomal hernia: A case report. World J Gastrointest Surg 2023; 15:294-302. [PMID: 36896303 PMCID: PMC9988641 DOI: 10.4240/wjgs.v15.i2.294] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/25/2022] [Accepted: 02/09/2023] [Indexed: 02/27/2023] Open
Abstract
BACKGROUND In recent years, mesh has become a standard repair method for parastomal hernia surgery due to its low recurrence rate and low postoperative pain. However, using mesh to repair parastomal hernias also carries potential dangers. One of these dangers is mesh erosion, a rare but serious complication following hernia surgery, particularly parastomal hernia surgery, and has attracted the attention of surgeons in recent years.
CASE SUMMARY Herein, we report the case of a 67-year-old woman with mesh erosion after parastomal hernia surgery. The patient, who underwent parastomal hernia repair surgery 3 years prior, presented to the surgery clinic with a complaint of chronic abdominal pain upon resuming defecation through the anus. Three months later, a portion of the mesh was excreted from the patient’s anus and was removed by a doctor. Imaging revealed that the patient’s colon had formed a t-branch tube structure, which was formed by the mesh erosion. The surgery reconstructed the structure of the colon and eliminated potential bowel perforation.
CONCLUSION Surgeons should consider mesh erosion since it has an insidious development and is difficult to diagnose at the early stage.
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Affiliation(s)
- Yu Zhang
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Han Lin
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Jia-Ming Liu
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Xin Wang
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Yi-Feng Cui
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Zhao-Yang Lu
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
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4
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Chin X, Nicol A, Ng JYS. Mesh migration mimicking sigmoid diverticulitis. ANZ J Surg 2021; 92:902-903. [PMID: 34478228 DOI: 10.1111/ans.17188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/08/2021] [Accepted: 08/23/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Xinlin Chin
- Surgical Division, Mackay Base Hospital, Mackay, Queensland, Australia.,School of Medicine, Griffith University, Birtinya, Queensland, Australia
| | - Alice Nicol
- Surgical Division, Mater Hospital Brisbane, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Jessica Yan-Seen Ng
- Surgical Division, Mackay Base Hospital, Mackay, Queensland, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia.,Faculty of Medicine, School of Medicine, The University of Queensland, Herston, Queensland, Australia
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5
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Van Hoef S, Zwaans WAR, Luijten A. Sciatic hernia: repair after recurrence. BMJ Case Rep 2021; 14:e238755. [PMID: 33853813 PMCID: PMC8054052 DOI: 10.1136/bcr-2020-238755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2021] [Indexed: 11/03/2022] Open
Abstract
Sciatic hernia is a rare pelvic floor hernia. A variety of treatment modalities were proposed, but a guideline is lacking although a mesh-based tension-free repair may be preferred. A 67-year-old woman with an uncomplicated sciatic hernia received primarily closing of the hernia orifice that was covered with a preperitoneal mesh in March 2019. Six months later, she developed a clinical and radiographical recurrence requiring remedial surgery. Due to the previous mesh fixation, the preperitoneal plane was obliterated. Therefore, the pouch of Douglas was closed, leaving the hernia sac in place, by folding two opposing peritoneal layers and covering it with a Ventralight ST mesh. After 9 months, the hernia had not recurred and the patient was symptom-free. It is concluded that recurrent sciatic hernia may be treated by obliterating the Douglas pouch and subsequent mesh coverage.
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Affiliation(s)
- Stijn Van Hoef
- General Surgery, Maxima Medical Center, Veldhoven, The Netherlands
| | | | - Arijan Luijten
- General Surgery, Maxima Medical Center, Veldhoven, The Netherlands
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6
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Chandrasinghe P, De Silva A, Welivita A, Deen K. Complete migration of a composite mesh into small bowel incidentally found during laparotomy for colectomy in an asymptomatic patient: a case report. J Med Case Rep 2020; 14:207. [PMID: 33126917 PMCID: PMC7602325 DOI: 10.1186/s13256-020-02540-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 09/21/2020] [Indexed: 11/29/2022] Open
Abstract
Background Composite meshes are used for incisional hernia repair because they enable intraperitoneal mesh placement due to their dorsal surface, which is made of inert material. We report, for the first time, to our knowledge, a case of composite mesh migration detected incidentally during a laparotomy for colon cancer in an asymptomatic patient. Case presentation Our patient was a 71-year-old South Asian man who underwent ventral mesh repair following a postoperative complication after right hemicolectomy for colon cancer. The patient was diagnosed with a metachronous sigmoid cancer 5 years later, for which he underwent laparotomy. During laparotomy, a migrated mesh was incidentally found and extracted from his proximal ileum without any evidence of abscess or fistula formation. Conclusion To our knowledge, this is the first report of an incidentally found migrated composite mesh from a bowel lumen in an asymptomatic patient.
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Affiliation(s)
- Pramodh Chandrasinghe
- Department of Surgery, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
| | - Asantha De Silva
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
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7
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Lee Y, Bae BN. Transmural Mesh Migration From the Abdominal Wall to the Rectum After Hernia Repair Using a Prolene Mesh: A Case Report. Ann Coloproctol 2020; 37:S28-S33. [PMID: 32674553 PMCID: PMC8359694 DOI: 10.3393/ac.2020.04.19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 04/19/2020] [Indexed: 12/29/2022] Open
Abstract
Mesh erosion or migration is a rare and late complication after hernia repair. Its incidence is increasing as the utilization of prosthetic mesh gains popularity for abdominal hernia repair. However, mesh migration is exceedingly rare and its clinical presentation is atypical and diverse. Therefore, the management of mesh migration should be individualized to each patient. This research reports the case of a 94-year-old man with transmural migration of Prolene mesh (Ethicon) from the abdominal wall to the rectum 14 years after incisional hernia repair. He presented with only chronic abdominal pain and constipation. Migration of the mesh and a fistula between the right abdominal wall and transverse colon was observed on computed tomography. The mesh was evacuated manually from the anus without any sequelae. These findings made this case atypical, since complete transluminal migration of mesh is exceedingly rare and mesh erosion or migration requires surgical treatment in many cases.
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Affiliation(s)
- Yujin Lee
- Department of General Surgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Byung-Noe Bae
- Department of General Surgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
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8
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AlShammari A, Alyousef F, Alyousif A, Alsulabi Z, AlJishi F, Siraj I, Alotaibi H, Aburahmah M. Chronic abdominal pain after laparoscopic hernia repair due to mesh graft migration to the cecum: a case report. Patient Saf Surg 2019; 13:37. [PMID: 31788028 PMCID: PMC6880573 DOI: 10.1186/s13037-019-0220-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 11/12/2019] [Indexed: 11/10/2022] Open
Abstract
Background Hernia repair with mesh graft is one of the most common procedures in general surgery. Mesh graft repair is the treatment of choice for umbilical and periumbilical hernias to minimize recurrence. One of the rare but serious complications is mesh graft migration to viscus. These complications can occur months to years after repair and their diagnosis can be challenging as they may present as vague abdominal pain only. Case presentation A 74-year-old gentleman with multiple medical comorbidities was diagnosed with a para-umbilical hernia after which he underwent a laparoscopic hernia repair at our hospital using a mesh graft with no complications. On postoperative day 10, he presented to the emergency room (ER) complaining of colicky abdominal pain in the right iliac fossa for 1 day associated with diarrhea. A Computed Tomography (CT) scan of the abdomen and pelvis showed diffuse wall thickening of the cecum and terminal ileum with small free air worrisome for perforation. The decision was made in the ER to discharge him home on antibiotics. The patient then returned back multiple times to the ER for the same complaint along with bleeding per rectum for which he underwent further investigations. Months later, the patient presented again with the same symptoms. A CT scan revealed recurrence of a periumbilical hernia and thickening of the medial wall of the cecum with mesh graft material. The patient was then taken to surgery and intra-operative findings revealed migration of almost 50% of the mesh graft size to the cecum and part of the mesh graft was eroding the distal part of ileum just proximal to the ileocecal junction. Adhesolysis and limited right hemicolectomy with ileocolic anastomosis was done. The patient had an uneventful recovery after revisions surgery without any perioperative complications. He was discharged home on postoperative readmission day 5 and followed up at 2 weeks and 3 months without any delayed complications or subjective complaints. Conclusion It is important to consider mesh graft migration to viscus as a cause of persistent abdominal pain and bleeding per rectum irrespective of the time of presentation post hernia repair.
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Affiliation(s)
- Abdullah AlShammari
- 1College of Medicine, Alfaisal University, P.O. Box 50927, Riyadh, 11533 Saudi Arabia.,2Department of Surgery, King Faisal Specialist Hospital and Research Center (KFSH&RC), P. O. Box 3354, Riyadh, 11211 Saudi Arabia
| | - Fatima Alyousef
- 1College of Medicine, Alfaisal University, P.O. Box 50927, Riyadh, 11533 Saudi Arabia
| | - Amal Alyousif
- 1College of Medicine, Alfaisal University, P.O. Box 50927, Riyadh, 11533 Saudi Arabia
| | - Zainab Alsulabi
- 1College of Medicine, Alfaisal University, P.O. Box 50927, Riyadh, 11533 Saudi Arabia
| | - Fatimah AlJishi
- 1College of Medicine, Alfaisal University, P.O. Box 50927, Riyadh, 11533 Saudi Arabia
| | - Isra Siraj
- 1College of Medicine, Alfaisal University, P.O. Box 50927, Riyadh, 11533 Saudi Arabia
| | - Hissah Alotaibi
- 1College of Medicine, Alfaisal University, P.O. Box 50927, Riyadh, 11533 Saudi Arabia
| | - Mohammad Aburahmah
- 1College of Medicine, Alfaisal University, P.O. Box 50927, Riyadh, 11533 Saudi Arabia.,2Department of Surgery, King Faisal Specialist Hospital and Research Center (KFSH&RC), P. O. Box 3354, Riyadh, 11211 Saudi Arabia
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9
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Manzini G, Henne-Bruns D, Kremer M. Severe complications after mesh migration following abdominal hernial repair: report of two cases and review of literature. GMS INTERDISCIPLINARY PLASTIC AND RECONSTRUCTIVE SURGERY DGPW 2019; 8:Doc09. [PMID: 31275799 PMCID: PMC6545489 DOI: 10.3205/iprs000135] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: Migration of mesh after ventral and incisional hernia repair is a rare but well described complication. The aim of our work is to present two cases of mesh migration after incisional hernia repair and to review the current literature. Methods: We describe the two cases of mesh migration that occurred at our department. Additionally, we performed a systematic literature search. Results: In both cases we observed a mesh migration with formation of an entero-cutaneous fistula that required surgical therapy. In the literature search we found a total of 16 publications dealing with mesh migration after incisional (n=14) and ventral hernia (n=2) repair in adult patients (15 case reports and one retrospective study). In 9 out of 15 patients (54%) who presented with mesh migration or erosion, a polypropylene mesh was responsible for this complication. Conclusions: Mesh migration after abdominal hernia repair is rare, the only available retrospective study reports a rate of 2.7%. The ability of polypropylene mesh to migrate into hollow viscera is well known and confirmed both by our data and the results of the literature review. As the incidence of mesh erosion/migration is significantly lower than the recurrence rate after hernia repair without mesh, up to now, no better alternative exists for the treatment of abdominal wall hernia than mesh augmentation.
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Affiliation(s)
- Giulia Manzini
- Department of General and Visceral Surgery, University Hospital of Ulm, Germany
| | - Doris Henne-Bruns
- Department of General and Visceral Surgery, University Hospital of Ulm, Germany
| | - Michael Kremer
- Department of General and Visceral Surgery, University Hospital of Ulm, Germany.,Department of General and Visceral Surgery, Kantonsspital Aarau, Switzerland
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10
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De Marchi J, Sferle FR, Hehir D. Laparoscopic ventral hernia repair with intraperitoneal onlay mesh-results from a general surgical unit. Ir J Med Sci 2019; 188:1357-1362. [PMID: 30945113 DOI: 10.1007/s11845-019-02012-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 03/21/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Symptomatic ventral herniation is a common clinical presentation. The treatment, whether elective or as an emergency, can be difficult and a variety of surgical repairs are utilised. Intraperitoneal onlay mesh (IPOM) involves the placement of a reinforcing prosthesis, usually supported by primary closure of the defect. Intra-abdominal adhesions have been highlighted as a potential complication in utilising this form of mesh placement. Several methods of laparoscopic mesh placement outside of the peritoneal cavity are gaining prominence as potential alternatives to IPOM. AIMS This study reviews our experience with IPOM in the repair of ventral hernia by a single surgical team. METHODS A prospectively maintained electronic database of all laparoscopic ventral hernia repair (LVHR) performed within the study period was analysed and reported. Follow-up questionnaires were sent to patients to follow long-term outcomes. RESULTS One hundred eight patients underwent LVHR over a 7-year period. Demographics demonstrated an obese patient group (BMI 30.89 ± 4.9 kg/m2), with a variety of hernia sizes and morphologies. Hernia recurrence was found in two patients (1.8%). Twenty-nine (26.8%) patients suffered a complication, but only eight (7.4%) of those required intervention beyond pharmacotherapy. Two patients required mesh explantation. CONCLUSIONS IPOM for the general surgeon is a relatively safe and effective method of repairing ventral hernias, with a low recurrence rate.
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Affiliation(s)
- Joshua De Marchi
- Department of Surgery, Midlands Regional Hospital, Tullamore, Republic of Ireland.
| | - Florin Remus Sferle
- Department of Surgery, Midlands Regional Hospital, Tullamore, Republic of Ireland
| | - Dermot Hehir
- Department of Surgery, Midlands Regional Hospital, Tullamore, Republic of Ireland
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11
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Patil AR, Nandikoor S, Mohanty HS, Godhi S, Bhat R. Mind the gap: imaging spectrum of abdominal ventral hernia repair complications. Insights Imaging 2019; 10:40. [PMID: 30923952 PMCID: PMC6439043 DOI: 10.1186/s13244-019-0730-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 03/07/2019] [Indexed: 12/04/2022] Open
Abstract
Ventral hernia repair with or without mesh placement is a commonly done procedure. Laparoscopic approach is more preferred than open in recent surgical practice. Complications occur as like any other abdominal surgeries and are dependent on multiple factors. Complications such as collections, adhesions, and related changes are non-specific. Specific complications related to hernia repair include recurrent hernia, mesh infection, mesh migration, and fistula formation. Post inguinal hernia repair chronic inguinal pain is gaining more attention with increasing use of image-guided nerve interventions for symptomatic management. Imaging plays a vital role in defining and delineating the type and extent of complications. Prior knowledge of the surgical indication and technique helps in better imaging interpretation of complications. This article describes the role of imaging in diagnosis of complications in general ventral hernia surgery setting.
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Affiliation(s)
- Aruna R Patil
- Department of Radiology, Apollo Hospitals, opp IIM, Bangalore, Karnataka, 560078, India.
| | - Shrivalli Nandikoor
- Department of Radiology, Apollo Hospitals, opp IIM, Bangalore, Karnataka, 560078, India
| | | | - Satyajit Godhi
- Surgical Gastroenterology, Apollo Hospitals, opp IIM, Bangalore, Karnataka, 560078, India
| | - Ravishankar Bhat
- Surgical Gastroenterology, Apollo Hospitals, opp IIM, Bangalore, Karnataka, 560078, India
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12
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Cunningham HB, Weis JJ, Taveras LR, Huerta S. Mesh migration following abdominal hernia repair: a comprehensive review. Hernia 2019; 23:235-243. [DOI: 10.1007/s10029-019-01898-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 01/22/2019] [Indexed: 12/11/2022]
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13
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Chronic anemia due to transmural e-PTFE anti-adhesive barrier mesh migration in the small bowel after open incisional hernia repair: A case report. Int J Surg Case Rep 2018; 53:54-57. [PMID: 30384142 PMCID: PMC6214886 DOI: 10.1016/j.ijscr.2018.10.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/20/2018] [Accepted: 10/07/2018] [Indexed: 11/23/2022] Open
Abstract
Mesh related unusual complication. Intraluminal mesh migration. Mesh erosion.
Introduction Meshes are commonly employed in abdominal hernia repair to reduce recurrence rates. Prosthetic repair, however, increases the risk of mesh related complications, including migration into adjacent viscera and erosion which can occur as uncommon and can be difficult to be diagnose. Presentation of case This is a case of transmural migration of composite mesh into the bowel, presenting as chronic abdominal pain and anemia 14 years after incisional hernia repair. Discussion Mesh implantation in hernia repair has increased the incidence of complications, such as seroma, hematoma and infection. Migration into adjacent viscera and erosion may present as complications related to the use of meshes. Their precise frequency after abdominal wall hernia repair is not well known and their late occurrence can make the diagnosis difficult. Conclusion Transmural migration of composite mesh is an uncommon complication of incisional hernia repair. Its pathogenesis is still not completely clear but it has been reported many years after implant surgery. It should be considered in a typical presentation of patients with history of previous prosthetic ventral hernia repair.
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Cunningham HB, Kukreja S, Huerta S. Mesh migration into an inguinal hernia sac following a laparoscopic umbilical hernia repair. Hernia 2018; 22:715-720. [PMID: 29605843 DOI: 10.1007/s10029-018-1759-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 03/10/2018] [Indexed: 11/25/2022]
Affiliation(s)
- H B Cunningham
- Surgical Service (112), VA North Texas Health Care System, 4500 S. Lancaster Road, Dallas, TX, 75216, USA
| | - S Kukreja
- Surgical Service (112), VA North Texas Health Care System, 4500 S. Lancaster Road, Dallas, TX, 75216, USA
| | - S Huerta
- Surgical Service (112), VA North Texas Health Care System, 4500 S. Lancaster Road, Dallas, TX, 75216, USA.
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Abstract
INTRODUCTION Worldwide, more than 20 million patients undergo groin hernia repair annually. The many different approaches, treatment indications and a significant array of techniques for groin hernia repair warrant guidelines to standardize care, minimize complications, and improve results. The main goal of these guidelines is to improve patient outcomes, specifically to decrease recurrence rates and reduce chronic pain, the most frequent problems following groin hernia repair. They have been endorsed by all five continental hernia societies, the International Endo Hernia Society and the European Association for Endoscopic Surgery. METHODS An expert group of international surgeons (the HerniaSurge Group) and one anesthesiologist pain expert was formed. The group consisted of members from all continents with specific experience in hernia-related research. Care was taken to include surgeons who perform different types of repair and had preferably performed research on groin hernia surgery. During the Group's first meeting, evidence-based medicine (EBM) training occurred and 166 key questions (KQ) were formulated. EBM rules were followed in complete literature searches (including a complete search by The Dutch Cochrane database) to January 1, 2015 and to July 1, 2015 for level 1 publications. The articles were scored by teams of two or three according to Oxford, SIGN and Grade methodologies. During five 2-day meetings, results were discussed with the working group members leading to 136 statements and 88 recommendations. Recommendations were graded as "strong" (recommendations) or "weak" (suggestions) and by consensus in some cases upgraded. In the Results and summary section below, the term "should" refers to a recommendation. The AGREE II instrument was used to validate the guidelines. An external review was performed by three international experts. They recommended the guidelines with high scores. The risk factors for inguinal hernia (IH) include: family history, previous contra-lateral hernia, male gender, age, abnormal collagen metabolism, prostatectomy, and low body mass index. Peri-operative risk factors for recurrence include poor surgical techniques, low surgical volumes, surgical inexperience and local anesthesia. These should be considered when treating IH patients. IH diagnosis can be confirmed by physical examination alone in the vast majority of patients with appropriate signs and symptoms. Rarely, ultrasound is necessary. Less commonly still, a dynamic MRI or CT scan or herniography may be needed. The EHS classification system is suggested to stratify IH patients for tailored treatment, research and audit. Symptomatic groin hernias should be treated surgically. Asymptomatic or minimally symptomatic male IH patients may be managed with "watchful waiting" since their risk of hernia-related emergencies is low. The majority of these individuals will eventually require surgery; therefore, surgical risks and the watchful waiting strategy should be discussed with patients. Surgical treatment should be tailored to the surgeon's expertise, patient- and hernia-related characteristics and local/national resources. Furthermore, patient health-related, life style and social factors should all influence the shared decision-making process leading up to hernia management. Mesh repair is recommended as first choice, either by an open procedure or a laparo-endoscopic repair technique. One standard repair technique for all groin hernias does not exist. It is recommended that surgeons/surgical services provide both anterior and posterior approach options. Lichtenstein and laparo-endoscopic repair are best evaluated. Many other techniques need further evaluation. Provided that resources and expertise are available, laparo-endoscopic techniques have faster recovery times, lower chronic pain risk and are cost effective. There is discussion concerning laparo-endoscopic management of potential bilateral hernias (occult hernia issue). After patient consent, during TAPP, the contra-lateral side should be inspected. This is not suggested during unilateral TEP repair. After appropriate discussions with patients concerning results tissue repair (first choice is the Shouldice technique) can be offered. Day surgery is recommended for the majority of groin hernia repair provided aftercare is organized. Surgeons should be aware of the intrinsic characteristics of the meshes they use. Use of so-called low-weight mesh may have slight short-term benefits like reduced postoperative pain and shorter convalescence, but are not associated with better longer-term outcomes like recurrence and chronic pain. Mesh selection on weight alone is not recommended. The incidence of erosion seems higher with plug versus flat mesh. It is suggested not to use plug repair techniques. The use of other implants to replace the standard flat mesh in the Lichtenstein technique is currently not recommended. In almost all cases, mesh fixation in TEP is unnecessary. In both TEP and TAPP it is recommended to fix mesh in M3 hernias (large medial) to reduce recurrence risk. Antibiotic prophylaxis in average-risk patients in low-risk environments is not recommended in open surgery. In laparo-endoscopic repair it is never recommended. Local anesthesia in open repair has many advantages, and its use is recommended provided the surgeon is experienced in this technique. General anesthesia is suggested over regional in patients aged 65 and older as it might be associated with fewer complications like myocardial infarction, pneumonia and thromboembolism. Perioperative field blocks and/or subfascial/subcutaneous infiltrations are recommended in all cases of open repair. Patients are recommended to resume normal activities without restrictions as soon as they feel comfortable. Provided expertise is available, it is suggested that women with groin hernias undergo laparo-endoscopic repair in order to decrease the risk of chronic pain and avoid missing a femoral hernia. Watchful waiting is suggested in pregnant women as groin swelling most often consists of self-limited round ligament varicosities. Timely mesh repair by a laparo-endoscopic approach is suggested for femoral hernias provided expertise is available. All complications of groin hernia management are discussed in an extensive chapter on the topic. Overall, the incidence of clinically significant chronic pain is in the 10-12% range, decreasing over time. Debilitating chronic pain affecting normal daily activities or work ranges from 0.5 to 6%. Chronic postoperative inguinal pain (CPIP) is defined as bothersome moderate pain impacting daily activities lasting at least 3 months postoperatively and decreasing over time. CPIP risk factors include: young age, female gender, high preoperative pain, early high postoperative pain, recurrent hernia and open repair. For CPIP the focus should be on nerve recognition in open surgery and, in selected cases, prophylactic pragmatic nerve resection (planned resection is not suggested). It is suggested that CPIP management be performed by multi-disciplinary teams. It is also suggested that CPIP be managed by a combination of pharmacological and interventional measures and, if this is unsuccessful, followed by, in selected cases (triple) neurectomy and (in selected cases) mesh removal. For recurrent hernia after anterior repair, posterior repair is recommended. If recurrence occurs after a posterior repair, an anterior repair is recommended. After a failed anterior and posterior approach, management by a specialist hernia surgeon is recommended. Risk factors for hernia incarceration/strangulation include: female gender, femoral hernia and a history of hospitalization related to groin hernia. It is suggested that treatment of emergencies be tailored according to patient- and hernia-related factors, local expertise and resources. Learning curves vary between different techniques. Probably about 100 supervised laparo-endoscopic repairs are needed to achieve the same results as open mesh surgery like Lichtenstein. It is suggested that case load per surgeon is more important than center volume. It is recommended that minimum requirements be developed to certify individuals as expert hernia surgeon. The same is true for the designation "Hernia Center". From a cost-effectiveness perspective, day-case laparoscopic IH repair with minimal use of disposables is recommended. The development and implementation of national groin hernia registries in every country (or region, in the case of small country populations) is suggested. They should include patient follow-up data and account for local healthcare structures. A dissemination and implementation plan of the guidelines will be developed by global (HerniaSurge), regional (international societies) and local (national chapters) initiatives through internet websites, social media and smartphone apps. An overarching plan to improve access to safe IH surgery in low-resource settings (LRSs) is needed. It is suggested that this plan contains simple guidelines and a sustainability strategy, independent of international aid. It is suggested that in LRSs the focus be on performing high-volume Lichtenstein repair under local anesthesia using low-cost mesh. Three chapters discuss future research, guidelines for general practitioners and guidelines for patients. CONCLUSIONS The HerniaSurge Group has developed these extensive and inclusive guidelines for the management of adult groin hernia patients. It is hoped that they will lead to better outcomes for groin hernia patients wherever they live. More knowledge, better training, national audit and specialization in groin hernia management will standardize care for these patients, lead to more effective and efficient healthcare and provide direction for future research.
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Tsapralis D, Vasiliades G, Zaxou Z, Delimpaltadaki M, Margetousakis TH, Papadakis H, Machairas A, Misiakos EP. Bowel obstruction secondary to migration of a Ventralex mesh: report of a rare complication. Hernia 2018; 22:711-714. [PMID: 29372340 DOI: 10.1007/s10029-017-1720-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 12/27/2017] [Indexed: 11/24/2022]
Affiliation(s)
- D Tsapralis
- Department of General Surgery, General Hospital/Health Center of Ierapetra, Ierapetra, Crete, Greece
| | - G Vasiliades
- Department of General Surgery, General Hospital/Health Center of Ierapetra, Ierapetra, Crete, Greece
| | - Z Zaxou
- Department of General Surgery, General Hospital/Health Center of Ierapetra, Ierapetra, Crete, Greece
| | - M Delimpaltadaki
- Department of General Surgery, General Hospital/Health Center of Ierapetra, Ierapetra, Crete, Greece
| | - T H Margetousakis
- Department of General Surgery, General Hospital/Health Center of Ierapetra, Ierapetra, Crete, Greece
| | - H Papadakis
- Department of General Surgery, General Hospital/Health Center of Ierapetra, Ierapetra, Crete, Greece
| | - A Machairas
- 3rd Department of General Surgery, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, Chaidari, Athens, Greece
| | - E P Misiakos
- 3rd Department of General Surgery, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, Chaidari, Athens, Greece.
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Yang GPC. From intraperitoneal onlay mesh repair to preperitoneal onlay mesh repair. Asian J Endosc Surg 2017; 10:119-127. [PMID: 28547932 DOI: 10.1111/ases.12388] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 04/12/2017] [Indexed: 11/30/2022]
Abstract
Laparoscopic repair for ventral and incisional hernias was first reported in the early 1990s. It uses intraperitoneal only mesh placement to achieve a tension-free repair of the hernia. However, in recent years, there has been greater concern about long-term complication involving intraperitoneal mesh placement. Many case reports and case series have found evidence of mesh adhesion, mesh fistulation, and mesh migration into hollow organs including the esophagus, small bowel, and large bowel, resulting in various major acute abdominal events. Subsequent management of these complications may require major surgery that is technically demanding and difficult; in such cases, laparotomy and bowel resection have often been performed. Because of these significant, but not common, adverse events, many surgeons favor open sublay repair for ventral and incisional hernias. Investigators are therefore searching for a laparoscopic approach for ventral and incisional hernias that might overcome the mesh-induced visceral complications seen after intraperitoneal only mesh placement repair. Laparoscopic preperitoneal onlay mesh is one such approach. This article will explore the fundamental of intraperitoneal only mesh placement and its problems, the currently available peritoneal visceral-compatible meshes, and upcoming developments in laparoscopic ventral and incisional hernia repair. The technical details of preperitoneal onlay mesh, as well as its potential advantages and disadvantages, will also be discussed.
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CT findings of complications after abdominal wall repair with prosthetic mesh. Diagn Interv Imaging 2017; 98:517-528. [PMID: 28254193 DOI: 10.1016/j.diii.2017.01.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 12/19/2016] [Accepted: 01/01/2017] [Indexed: 01/10/2023]
Abstract
Postoperative complications following prosthetic mesh repair are relatively rare and depend on the type and location of prosthetic mesh. They include abscess, hematoma, seroma, fistula, bowel obstruction, mesh retraction, granuloma and recurrent hernia. Computed tomography (CT) is the imaging examination of choice for the diagnosis of such complications. This pictorial review illustrates the CT presentation of the most and less common postoperative complications following prosthetic mesh repair of the abdominal wall.
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A Rare Complication of Composite Dual Mesh: Migration and Enterocutaneous Fistula Formation. Case Rep Surg 2015; 2015:293659. [PMID: 26550515 PMCID: PMC4621324 DOI: 10.1155/2015/293659] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 10/05/2015] [Indexed: 11/18/2022] Open
Abstract
Introduction. Mesh is commonly employed for abdominal hernia repair because it ensures a low recurrence rate. However, enterocutaneous fistula due to mesh migration can occur as a very rare, late complication, for which diagnosis is very difficult. Presentation of Case. Here we report the case of an enterocutaneous fistula due to late mesh migration in a mentally retarded, diabetic, 35-year-old male after umbilical hernia repair with composite dual mesh in 2010. Discussion. Mesh is a foreign substance, because of that some of the complications including hematoma, seroma, foreign body reaction, organ damage, infection, mesh rejection, and fistula formation may occur after implantation of the mesh. In the literature, most cases of mesh-associated enterocutaneous fistula due to migration involved polypropylene meshes. Conclusion. This case serves as a reminder of migration of composite dual meshes.
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