Laparoscopic Management of Prosthetic Infections Following Laparoscopic Groin Hernioplasty — Experiences from a Tertiary Care Center

Abstract

Despite increasing trends towards laparoscopic groin hernioplasty, its early prosthesis-related complications have hardly been addressed. Although conventionally treated by an open approach, we describe our experience with the laparoscopic management of infected meshes. We retrospectively evaluated 9 patients (5 were referred and 4 from our center) with groin abscesses due to infected meshes following laparoscopic hernioplasty from January 2003 to 2015 in whom surgical intervention was deemed necessary. One patient had his mesh migrated into the urinary bladder, which was laparoscopically removed. The mean operative time was 76 minutes and mean hospital stay was 7.5 days. All the infected meshes were removed laparoscopically via endobags without any conversions. One patient had MRSA mesh infection and 1 had tuberculosis, both of whom recovered completely with the appropriate antimicrobial therapy. One patient had chronic groin pain following infected mesh extraction that lasted for 10 months while one patient developed a recurrent hernia that was managed by open anatomical repair. The mean follow-up was 28 months. Mesh infections are classified as complicated and uncomplicated, and treatment depends on the type of infection type. Complicated mesh infections following laparoscopic groin hernioplasty often dictate mesh removal, requiring large incisions and the high morbidity of the open approach. However, optimal laparoscopic techniques for such patients would drastically diminish the morbidity and physiological insult without compromising surgical principles. Although large-volume studies are not possible as the incidence of mesh infection is very low, our series supports the feasibility of a laparoscopic approach in these difficult circumstances.