Mesh Erosion into the Urinary Bladder Post-Laparoscopic Inguinal Hernia Repair – A case report

Although rare, mesh migration or erosion into viscera has been reported as case report, and most of the cases involved with the urinary bladder. With the increasing use of prosthetic mesh in hernia repair, this severe complication would increase in the future; thus, we feel that it is necessary to analyze the clinical patterns of mesh erosion into the urinary bladder, and to discuss the prevention and treatment of this severe complication. In the present study, we made a thorough identification of all published reports on mesh migration or erosion into the urinary bladder, and the data were summarized, analysed, and discussed. A total of 23 cases of mesh erosion into urinary bladder were reported since 1994. Among them, two cases were from incisional hernia repairs, and 21 cases were following inguinal hernia repairs. The most frequently reported procedures were TAPP, followed by TEP. The duration from initial hernia repair to the onset of mesh erosion into bladder varied greatly (3months-20years), and most of cases occurred in 1-5years after the initial hernia repair (10/23, 43.5%), while a certain number of cases occurred 10years after hernia repair (6/23, 26.1%). Most of these cases were treated with mesh removal via a open procedure (12/22, 54.5%), and in 7 cases (7/22, 31.8%), the partial cystectomy was performed as well as mesh removal. Laparoscopic or robotic treatment procedures were performed in three cases. Mesh erosion into the urinary bladder can occur after both open and laparoscopic inguinal hernia repairs in a wide range of duration. This complication most frequently happened following laparoscopic inguinal hernia repair. It was usually treated with partial or complete mesh removal, with or without partial cystectomy. A registry system is necessary for monitoring this complication.

Repair of inguinal hernia is the most commonly performed surgical procedure. Both open and laparoscopic methods are accepted modalities of surgical treatment. Transabdominal preperitoneal (TAPP) and total extraperitoneal (TEP) are the two types of laparoscopic repair of the inguineal hernia. The main advantages of laparoscopic repair, as compared to open repair, are a shorter hospital stay and a quicker recovery to normal activities. However, laparoscopic repairs are associated with a higher incidence of visceral and vascular injuries. One particular complication is the migration and erosion of mesh into the adjacent viscera. Although the total numbers of cases are small, compared to the total numbers of inguinal hernia repairs, they are important, as they often presented with a diagnostic dilemma. Most of the mesh migrations reported in the literature involves the urinary bladder. In this paper, we present a case of erosion of mesh into the caecum. The patient (a 66-year-old male) underwent TAPP repair of a right inguinal hernia in 1996 with polypropelene mesh. He also underwent an open appendicectomy in 1980. During the laparoscopic repair, he was found to have multiple intra-abdominal adhesions. He presented with intermittent diarrhea, for which he was investigated, and a benign caecal lesion was found. He was initially managed conservatively. However, his symptoms persisted and he underwent a right hemicolectomy in February 2006 in our hospital. The offending lesion was found to be the prolene mesh having eroded into the caecum.

Tension-free mesh has been applied in abdominal hernia repairs as the gold-standard for repair to decrease hernia recurrence and post-operative pain. Common complications include infection, mesh rejection, and fistula formation. Mesh migration and erosion are uncommon, late-onset complications that can occur months to years after initial mesh placement. Clinical presentation depends on the organ into which the mesh erodes. While mesh fixation has been investigated recently, patients with historical repair are still at risk for this rare complication. We present an unusual case of a patient with mesh erosion into the sigmoid colon diagnosed on colonoscopy. Our patient is a 72-year-old male with history of double-hernia repair in the 1990s. He had recently presented to his primary care doctor for abdominal pain and a CT Abdomen was ordered, which noted postoperative changes of hernia repair. Patient was referred for EGD for nausea and abdominal pain and was already scheduled for a follow-up screening colonoscopy. EGD showed mild gastritis. Colonoscopy showed a foreign body in the mid-sigmoid colon that appeared to be mesh with spiral fasteners noted within the foreign body and appeared to be eroding through the wall of the sigmoid colon causing some luminal narrowing. Colonoscope was removed and patient was referred to general surgery. Patient was taken for surgery. The left inguinal region was attached to the sigmoid colon via the surgical mesh requiring complex dissection and removal of pus and infected material noted in this region. The mesh was removed, and patient's abdominal pain, nausea, and discomfort had resolved as noted on follow-up 2 weeks after. Mesh erosion and migration are late-complications of hernia repair that can cause severe symptoms for patients. D'Amore et al. identified seven previous cases (2 cecum and 5 left colon) of mesh erosion into the colon since 1997. There was one additional case report noting erosion of mesh into the sigmoid colon. There has been on-going discussion if fixation of hernias during mesh repair is required for prevention of erosion; however, our case had evidence of spiral fasteners that eroded along with the mesh. This is unusual as fixation is theorized to prevent this complication, and studies are ongoing to determine the outcomes comparing fixation to no fixation. Our case is important as it defines a case where fixation did not prevent mesh erosion and resulted in an infected mesh erosion.1474_A Figure 1. Colonoscopy showing evidence of fastener with mesh in colon1474_B Figure 2. Colonoscopy showing luminal narrowing in the sigmoid colon with mesh in place1474_C Figure 3. Colonoscopy again showing luminal narrowing with fastener once again seen

Introduction and importanceMesh migration into urinary bladder is one of the rare complications following inguinal hernia repair (Laparoscopic/Open). On reviewing the literature, erosion of mesh following inguinal hernia repair has been into the urinary bladder in most of the cases, and the erosion may occur as early or late complication. It may occur as a result of improper suturing, inadequate fixation or foreign body reaction. The most common presentation is recurrent urinary tract infection and haematuria and may mimic bladder malignancy. Case presentationA 38-year male presented with recurrent UTI and mimicked to have bladder malignancy on CT scan. On Cystoscopy, mesh along with tackers is visualized within the bladder lumen. A diagnosis of Mesh migration into bladder following laparoscopic inguinal hernia repair was made. The Patient underwent Complete laparoscopic removal of mesh with partial cystectomy, per urethral and suprapubic catheter were placed. The patient made a good recovery without any post-operative complications. On follow-up, Patient underwent Fluoroscopy to look for urinary leakage, and suprapubic catheter removal was done. Patient is asymptomatic on follow-up. Clinical discussionMesh migration into bladder is one the rare complications following laparoscopic hernia repair. Proper preoperative evaluation is necessary to determine whether mesh is free floating in the bladder lumen or adherent to bladder wall. This will help in deciding the surgical technique for route of extraction. ConclusionA case of mesh migration into the bladder can be easily managed by laparoscopic TAPP approach and it is better approach compared to other techniques.

BackgroundFew reports from the medical literature have presented severe mesh-related complications following laparoscopic repair of inguinal hernia. One of these complications is being mesh erosion into bowel, resulting in fistulous tract with subsequent abscess formation.Case presentationA 75-year-old patient, status post laparoscopic bilateral inguinal hernia repair, and on anticoagulation for dual prosthetic heart valves, presented with a unique case of sigmoid to scrotal fistula, post mesh erosion, resulting in sepsis. The patient presented in septic shock, necessitating an individualized surgical approach. Given the septic picture of our patient, the surgical approach was truncated. Initially the sepsis from the scrotum was drained and debrided. A watermelon seed was noted in the scrotum. After stabilization, the second stage approach was performed, were a laparotomy was performed, followed by division of the sigmoid to internal ring fistula, and reperitonealization of the mesh. Mesh removal was delayed as the risk of bleeding into the peritoneum was high, once anticoagulation needed to be resumed. Because of a persistent wound sinus tract, several months later, the mesh was removed, in a third stage, from an inguinal incision. Albeit meticulous dissection and homeostasis, a postoperative extraperitoneal inguinal hematoma developed, as expected, on day 2, once anticoagulation was resumed.ConclusionSigmoid to inguinoscrotal fistula is a rare, yet serious, complication of mesh infection and erosion. This can be obviated by preventing serosal tear, and proper peritonealization of the mesh. Fistulectomy alone with primary repair turned out to be a valid approach in our patient. Retaining the mesh could be an alternative for avoiding bleeding in patients on anticoagulation; despite that a persistent indolent infection and sinus tract will necessitate mesh removal afterwards.

Late complications of mesh repair are commonly due to mesh migration and erosion into neighbouring visceri. We report the first case of a mesh repair of a lower midline laprotomy incisional hernia complicated by erosion of the mesh into the bladder which presented as haematuria.

BackgroundHernia mesh erosion into the urinary bladder is a rare complication of hernioplasty, and mesh immigration is the most probable pathophysiology. There is no report describing mesh erosion induced by fixing tacks in inguinal hernia repair.Case presentationA 37-year-old man was admitted to our hospital with frequency, urgency and odynuria for 3 months. He received open right inguinal hernia repair in September 2014, and right laparoscopic hernioplasty for recurrence of the inguinal hernia in May 2015. In February 2019, he underwent a day-case transurethral cystoscopic operation for urethral and bladder stones. Cystoscopy revealed the existence of bladder stones and part of the eroded mesh on the right anterior wall, for which an open partial cystectomy was performed. The patient was followed up for 3 months postoperatively, during which no further mesh erosion or stone recurrence was detected by cystoscopy.ConclusionThis is the first case report describing mesh erosion into the urinary bladder by fixing tacks following laparoscopic inguinal hernia repair. In such a case, the eroded mesh and tacks need to be removed completely, but the effectiveness of a single transurethral procedure needs to be verified in more cases.

A 67-year-old man presented with recurrent sepsis, groin swelling, and lower urinary tract symptoms 12 years after bilateral TEP inguinal hernia repair. Diagnosis of mesh migration and erosion into the urinary bladder was made by cystoscopy. Exploration of the groin confirmed Prolene mesh erosion into the lateral wall of the urinary bladder. This is the second reported case following TEP repair. A review of the literature reveals eight reported cases following laparoscopic repair since 1994. The factors contributing to mesh migration and erosion are discussed. With large case series of mesh non-fixation being reported in world literature, it may be that the incidence of this complication will increase in the future. A lower diagnostic threshold and reporting of this complication should be encouraged.

Background: The use of prosthetic mesh is associated with a lower risk of hernia recurrence and hence is used commonly in hernia repair. Mesh migration and erosion into the gastrointestinal tract, albeit rare, is one of the most serious and challenging complications of hernia operations. Timely surgical intervention is an essential part in the management of this condition. Case Presentation: A 55-year-old Caucasian female was admitted with severe abdominal pain and chronic abdominal wall infection nine years after an incisional hernia repair with mesh. Computed tomography (CT) scan of the abdomen revealed mesh eroded into the small bowel with a surrounding abscess and a fistulous tract. Surgery involved resection of the small bowel segment containing the mesh followed by primary anastomosis and complete excision of the remaining mesh. An adnexal pelvic mass was also excised. Despite a post-operative surgical site infection the patient was well at follow-up. Conclusion: This report emphasizes the importance of timely surgical intervention in patients with mesh erosion into the gastrointestinal tract. Moreover, surgeons should be aware of the increased risks of mesh erosion and enterocutaneous fistula if native tissue is not interposed between the mesh and the bowel in underlay and sub-fascial hernia repair techniques.

Mesh erosion into visceral organs is a rare complication following laparoscopic mesh repair for inguinal hernia with only 15 cases reported in English literature. We report the first case of complete laparoscopic management of mesh erosion into small bowel and urinary bladder. A 62-year-male underwent laparoscopic total extra-peritoneal repair of left inguinal hernia at another centre in April 2012. He presented to our centre 21 months later with persistent lower urinary tract infection (UTI). On evaluation mesh erosion into bowel and urinary bladder was suspected. At laparoscopy, a small bowel loop was adhered to the area of inflammation in the left lower abdomen. After adhesiolysis, mesh was seen to be eroding into small bowel. The entire infected mesh was pulled out from the pre-peritoneal space and urinary bladder wall using gentle traction. The involved small bowel segment was resected, and bowel continuity restored using endoscopic linear cutter. The resected bowel along with the mesh was extracted in a plastic bag. Intra-operative test for leak from urinary bladder was found to be negative. The patient recovered uneventfully and is doing well at 12 months follow-up with resolution of UTI. Laparoscopic approach to mesh erosion is feasible as the plane of mesh placement during laparoscopic hernia repair is closer to peritoneum than during open hernia repair.

Fascia lata transabdominal pre-peritoneal repair in incarcerated inguinal hernia (FL TAPP) – A case report

In recent years, mesh has become a standard repair method for parastomal hernia surgery due to its low recurrence rate and low postoperative pain. However, using mesh to repair parastomal hernias also carries potential dangers. One of these dangers is mesh erosion, a rare but serious complication following hernia surgery, particularly parastomal hernia surgery, and has attracted the attention of surgeons in recent years. Herein, we report the case of a 67-year-old woman with mesh erosion after parastomal hernia surgery. The patient, who underwent parastomal hernia repair surgery 3 years prior, presented to the surgery clinic with a complaint of chronic abdominal pain upon resuming defecation through the anus. Three months later, a portion of the mesh was excreted from the patient's anus and was removed by a doctor. Imaging revealed that the patient's colon had formed a t-branch tube structure, which was formed by the mesh erosion. The surgery reconstructed the structure of the colon and eliminated potential bowel perforation. Surgeons should consider mesh erosion since it has an insidious development and is difficult to diagnose at the early stage.

Mesh erosion or migration is a rare and late complication after hernia repair. Its incidence is increasing as the utilization of prosthetic mesh gains popularity for abdominal hernia repair. However, mesh migration is exceedingly rare and its clinical presentation is atypical and diverse. Therefore, the management of mesh migration should be individualized to each patient. This research reports the case of a 94-year-old man with transmural migration of Prolene mesh (Ethicon) from the abdominal wall to the rectum 14 years after incisional hernia repair. He presented with only chronic abdominal pain and constipation. Migration of the mesh and a fistula between the right abdominal wall and transverse colon was observed on computed tomography. The mesh was evacuated manually from the anus without any sequelae. These findings made this case atypical, since complete transluminal migration of mesh is exceedingly rare and mesh erosion or migration requires surgical treatment in many cases.

With increasing utilisation of meshes in inguinal hernia repair, reports of mesh-related complications are emerging, particularly late visceral complications, with mesh migration and erosion into the small bowel, bladder and...

Mesh erosion to urinary bladder causing fistulation to abdominal wall resulting in necrotizing fasciitis: A case report of late complication of incisional hernia