[Late intestinal fistula following implantation of parietal abdominal prostheses]
1Service de chirurgie générale et digestive, CHU Côte-de-Nacre, 14033 Caen, France.
Study Aim:
The aim of this retrospective study was to describe an unusual complication of the nonabsorbable meshes used for repair of incisional hernia or inguinal hernia.
Patients And Methods:
This study included eight observations of intestinal fistulas that occurred between 1 and 13 years after using Mersilène (Dacron) mesh for repair of an incisional hernia (7 cases) and an inguinal hernia (1 case). There were 6 men and 2 women (mean age: 58 years, range: 35-85 years) with an external intestinal fistula (n = 6) or an internal intestinal fistula (n = 2). All the patients required a reoperation for extraction of the mesh and treatment of the bowel injuries.
Results:
There was one secondary death in a 85 years old woman in relation with a vascular complication after incomplete excision of the prosthesis. In five patients out of six, there was a recurrence of the incisional hernia.
Conclusion:
The intestinal fistulas associated with prosthetic repair of the abdominal wall are mostly observed with intraperitoneal mesh but this factor is not exclusive. Their frequency after repair of incisional or inguinal hernia with non absorbable mesh is estimated between 0.3 and 3.5%. The use of nonabsorbable mesh should be limited to the indications of strict necessity, without any septic context or emergency surgery. The contact of the mesh with the bowel should be formally avoided.
Insights
Nonabsorbable mesh used for hernia repair can cause serious intestinal fistulas years later. Limiting mesh use and avoiding bowel contact is recommended to prevent these complications.
Area of Science:
- General Surgery
- Surgical Materials Science
Context:
- Incisional and inguinal hernias are commonly repaired using nonabsorbable synthetic meshes.
- Complications associated with these meshes, while rare, can be severe and lead to significant patient morbidity.
Purpose:
- To describe an unusual complication of nonabsorbable meshes (Mersilène/Dacron) used in incisional and inguinal hernia repair.
- To report on the occurrence of intestinal fistulas following mesh implantation.
Summary:
- This retrospective study analyzed eight cases of intestinal fistulas developing 1-13 years after Mersilène mesh repair for incisional (7 cases) or inguinal (1 case) hernias.
- Patients presented with external (6) or internal (2) fistulas, requiring reoperation for mesh removal and bowel injury treatment. One patient died post-operatively due to vascular complications. Incisional hernia recurrence was noted in five of six patients.
Impact:
- Intestinal fistulas post-mesh repair are estimated to occur in 0.3-3.5% of cases.
- Findings suggest limiting the use of nonabsorbable meshes to essential indications, avoiding septic or emergency scenarios, and strictly preventing mesh-bowel contact to minimize risks.
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