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Fecal fistula: a late complication of Marlex mesh repair
Abstract:
Marlex mesh is an excellent prosthetic material for closure of major abdominal defects. Most of its complications are seroma and infections. We have used Marlex mesh intraperitoneally for closure of burst abdomen in a patient who had a gastrectomy for recurrent duodenal ulcer. A year and a half later, this patient developed a fecal fistula to the skin due to incorporation of the Marlex mesh into the splenic flexure of the COLON. The patient underwent a second operation during which the fistula was resected and the Marlex removed. We concluded that intraperitoneal placement of Marlex mesh is not recommended.
Insights
Marlex mesh is effective for abdominal defects but carries risks. Intraperitoneal placement led to a rare fecal fistula due to mesh incorporation into the colon, necessitating removal.
Area of Science:
- Surgical materials science
- Gastrointestinal surgery
- Abdominal wall reconstruction
Background:
- Marlex mesh is a common prosthetic for large abdominal wall defects.
- Common complications include seroma and infection.
- Its use in intraperitoneal settings for burst abdomen closure is less documented.
Observation:
- A patient with a history of gastrectomy underwent Marlex mesh repair for a burst abdomen.
- 18 months post-surgery, the patient developed a fecal fistula.
- The fistula was traced to Marlex mesh incorporation into the colon's splenic flexure.
Findings:
- Intraperitoneal Marlex mesh can integrate with visceral organs, specifically the colon.
- This integration can lead to severe complications like fecal fistulas.
- Surgical removal of the mesh and fistula resection were required.
Implications:
- Intraperitoneal Marlex mesh placement is not recommended for abdominal wall closure.
- Alternative mesh materials or placement techniques may be safer.
- Further research into long-term outcomes of intraperitoneal mesh is warranted.