P-055 LAPAROSCOPIC EXPLANTATION OF GROIN MESH WITH STAPLED EXCISION OF COLO CUTANEOUS FISTULA

Abstract

Abstract Aim Groin mesh explantation is a challenging situation and a multidisciplinary approach at index explantation surgery can avoid a long term catastrophic situation for the patient . Material & Method The history of the patient started a decade back with bilateral laparoscopic TAPP, following which he had swelling in both groin area with high grade fever . He was advised open bilateral groin exploration and explant of the mesh. Post procedure he was kept on antibiotics for few weeks and he was asymptomatic, he developed swelling again and started on anti mycobacterial treatment He presented four years with foul smelling discharge from the suprapubic area . CT Scan with sinogram revealed a communication with sigmoid colon and tacker from index surgery We planned laparoscopic approach, stapled excision of sigmoid-cutaneous fistula was performed . Removal of residual mesh and tacker from index under fluoroscopy guidance with skin tract excision .Intra op flexible sigmoidoscopy revealed no lumen compromise . Histopathology showed granulomatous inflammation for which he was started on atypical mycobacterial treatment for 9 months .He remains uneventful after 2 years of surgery . Conclusion Mesh infection should be avoided at index surgery with utmost care to aseptic precautions. Mesh explantation should be a part of multidisciplinary approach, radiology and colonoscopy were key investigations in this case . One should plan for a complete removal of mesh and tacker/s at index explantation surgery for safe long term outcomes .