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Central mesh failure after laparoscopic IPOM procedure
Jeroen Van Besien1, Koen Vindevoghel1, Casper Sommeling1
1a Department of General Surgery , OLV van Lourdes , Waregem , Belgium.
Abstract:
Central mesh failure after laparoscopic repair of a ventral hernia is a rare finding. We present a case of a 42-year-old man with clear umbilical hernia recurrence 4 years after IPOM procedure with an oxidized cellulose composite polypropylene mesh, using the double crown technique. Laparoscopy showed that a segment of small intestine herniated through a central defect in the prosthesis. A primary repair of the umbilical hernia recurrence was performed through a small transverse infraumbilical incision suturing both the fascia and mesh with interrupted non-resorbable monofilament sutures. A plausible explanation for this type of recurrence might be that the center of the mesh was further torn after an initial (micro) trauma induced by the tackers used for fixation.
Insights
Mesh failure after laparoscopic ventral hernia repair is rare. This case shows small intestine herniation through a defect in the mesh, suggesting potential trauma from fixation devices.
Area of Science:
- Abdominal Surgery
- Surgical Materials Science
- Hernia Repair
Background:
- Ventral hernia repair frequently utilizes prosthetic meshes.
- Laparoscopic intraperitoneal onlay mesh (IPOM) is a common technique.
- Mesh failure, though uncommon, can lead to hernia recurrence.
Observation:
- A 42-year-old male presented with umbilical hernia recurrence 4 years post-IPOM.
- Laparoscopy revealed small bowel herniation through a central defect in the composite polypropylene mesh.
- The mesh was secured using the double crown technique.
Findings:
- Central mesh failure occurred, resulting in hernia recurrence.
- The defect allowed visceral herniation.
- Primary repair involved suturing fascia and mesh with non-resorbable sutures.
Implications:
- This case highlights a rare complication of IPOM repair.
- Potential mesh failure mechanism involves initial trauma from fixation devices.
- Further investigation into mesh fixation methods and material integrity is warranted.
