Rare late mesh complications following inguinal prolene hernia system hernioplasty: report of three cases

We have treated three patients who developed late mesh infections 7 years after inguinal hernioplasty caused by contact of an underlay prolene hernia system (PHS) patch with the intestines. In two patients, the cause was the development of a fistula between the underlay patch preperitoneally positioned in Bogros space and the appendix, and in one, a sigmoid colon fistula that developed as a consequence of penetration of the underlay PHS patch into the sigmoid colon. In the patients with contact of an underlay PHS patch with the appendix, total PHS excision, appendectomy, McVay herniorrhaphy and drainage through a direct inguinal approach were applied. In the patient with a sigmoid colon lesion, total PHS excision, left hemicastration, suturing of the sigmoid colon fistula, and a McVay herniorrhaphy with drainage were performed through a direct inguinal approach, followed by midline laparotomy and protective bipolar ileostomy. Late mesh infection developing several years after PHS inguinal hernioplasty is usually the consequence of intestinal erosions and fistulas due to contact between the underlay PHS patch and the intestines.