Abstract
Objectives To describe our technique of percutaneous nephrolithotomy (PNL) in patients with mesh-repaired flank incisional hernia. Polypropylene mesh which is used for fascia strengthening in hernia repair elicits intense inflammatory reaction and the consequent fibrosis alters the characteristics of abdominal wall. Thus, prior history of flank hernia repair with mesh may result in percutaneous nephrolithotomy failure. Materials and Methods Demographic data, renal stones characteristics, and any complication during surgery and follow-up of patients who were treated by PNL during 2011 to 2020 and had mesh in their flank region were collected. Results Percutaneous nephrolithotomy was performed without any problem in 8 patients with guide of ultrasonography. Conclusion Based on our experience, ultrasound-guided PNL is feasible and hypothetically superior to fluoroscopy in such circumstances.
Highlights
Introduction of polypropylene mesh was a great step in successful management of hernia and significantly decreased the likelihood of recurrence [1]
Reoperation may be challenging in the mesh-covered regions due to intense inflammatory reaction and the consequent fibrosis alters the characteristics of abdominal wall [2]
Presence of scar tissue interferes with appropriate surgical access and the required tract dilatation during percutaneous nephrolithotomy (PNL) [3]
Summary
Introduction of polypropylene mesh was a great step in successful management of hernia and significantly decreased the likelihood of recurrence [1]. Reoperation may be challenging in the mesh-covered regions due to intense inflammatory reaction and the consequent fibrosis alters the characteristics of abdominal wall [2]. Presence of scar tissue interferes with appropriate surgical access and the required tract dilatation during percutaneous nephrolithotomy (PNL) [3]. In these occasions, ultrasound can serve as a guide, visualizing the region, including the scar and fibrotic tissues. We report application of ultrasound for facilitating surgical access during PNL in a patient with history of mesh-based flank hernia repair
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