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Laparoscopic Removal of an Infected Mesh Following TEP Procedure for Femoral Hernia with Omental Patch Closure of a
Yusuke Takahashi1, Daisuke Komatsu2, Hitoshi Seki1
1Department of Digestive Surgery, Nagano Municipal Hospital, Nagano, Japan.
Abstract:
BACKGROUND Mesh infection following inguinal hernia repair is rare, and mesh removal is mandatory. However, the laparoscopic approach is challenging to perform. Here, we present a case of laparoscopic repair of a mesh infection using a totally extraperitoneal approach (TEP). CASE REPORT A 76-year-old woman underwent repair of a right femoral hernia via TEP approach using a prosthetic mesh with unabsorbable tacks. A month and a half after the surgery, she reported pain in the right groin. Computed tomography revealed a subcutaneous abscess in the right groin. We suspected mesh infection and initially chose conservative management, which included percutaneous drainage and systemic antibiotic administration. Her symptoms temporarily resolved; however, symptom relapse and purulent discharge from the right groin were observed. We performed laparoscopic removal of the infected mesh and all tacks via the transabdominal preperitoneal approach. A drain was placed in the infected preperitoneal space, and the peritoneal defect was covered using the greater omentum. The patient's postoperative course was uneventful, and she was discharged on postoperative day 20. Infection relapse, symptoms of femoral hernia, and adhesive intestinal obstruction have not been observed. CONCLUSIONS A laparoscopic approach for mesh infection after TEP hernia repair is feasible, even if the mesh is fixed using a tack. Greater omental use for peritoneal defects is useful in clinical situations associated with a contaminated surgical field.
Insights
Laparoscopic mesh removal is a feasible option for treating mesh infections after totally extraperitoneal (TEP) inguinal hernia repair. This approach, even with tacks, offers a viable solution for complex cases.
Area of Science:
- Minimally Invasive Surgery
- Surgical Infections
- Hernia Repair
Background:
- Mesh infection is a rare but serious complication of inguinal hernia repair, necessitating mesh removal.
- Laparoscopic mesh removal presents technical challenges, particularly after totally extraperitoneal (TEP) procedures.
- Prosthetic mesh fixation with tacks can complicate subsequent removal.
Observation:
- A 76-year-old woman developed a groin abscess post-TEP hernia repair with mesh and tacks.
- Initial conservative management (drainage, antibiotics) failed, leading to symptom relapse and purulent discharge.
- Laparoscopic mesh and tack removal was performed using a transabdominal preperitoneal approach.
Findings:
- The laparoscopic mesh removal was technically successful, with complete excision of the infected mesh and tacks.
- The patient recovered well postoperatively, with no recurrence of infection or hernia.
- The greater omentum was utilized to cover the peritoneal defect in the contaminated surgical field.
Implications:
- Laparoscopic mesh removal is a feasible and effective treatment for mesh infections following TEP hernia repair.
- The use of greater omentum can be beneficial for closing peritoneal defects in contaminated surgical fields.
- This case highlights successful management of a challenging surgical complication, improving patient outcomes.
