[Late complication after mesh repair of incisional hernias: pseudocyst formation]

Using mesh for hernia repair is a very common procedure; they are particularly useful for postoperative incisional hernias. The most common complications of mesh repair are seroma, haematoma or abscess formation. Previous literature data suggested that fibrotic cyst formation appearing in the late postoperative period is relatively rare. However, more recent studies and our own experience indicate that its incidence is more common and we have to consider it in the differential diagnosis of the complications of hernia repair.

148 incisional hernia mesh repairs were carried out between a period of 1st January, 2001 to 31st December, 2005. Fibrotic pseudocyst formation was observed in five cases. All developed as a late complication between 4 to 25 months postoperatively. An onlay polypropylene mesh was used in each case. All five patients underwent a wide excision of the pseudocyst wall and they recovered without complications.

The etiology of pseudocyst formation is unclear. Nevertheless, a possible relationship between the development of seroma and haematoma can not be ruled out, despite no fibrotic pseudocyst formation was observed in the early postoperative period. There is no evidence whether the characteristics of the mesh or the way of implantation would have any effect on pseudocyst formation, as well. It is noted that the only treatment of this late complication is surgical excision. Pseudocyst formation might be prevented by the application of sublay and minimally invasive techniques.