Mesh Migration Results in Asymptomatic Sigmoid Perforation as Long-Term Complication After Difficult TAPP: a Case Report
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SURGERY
Mesh Migration Results in Asymptomatic Sigmoid Perforation as Long-Term Complication After Difficult TAPP: a Case Report Kim R. Liedtke 1
&
Claudia Liedtke 1 & Annabel Kleinwort 1 & Paula Döring 2 & Anne S. Glitsch 1 & André Schreiber 1
Accepted: 6 April 2020 / Published online: 24 April 2020 # The Author(s) 2020
Abstract Hernia surgery is the most common surgical procedure worldwide. Complications are very rare and usually manifest in recurrence or chronic pain. We report a rare case of mesh migration 14 years after initially complicated transabdominal preperitoneal plastic for left-sided inguinal hernia. The mesh migration resulted in a covered sigmoid perforation, which was completely asymptomatic and only noticed as a chance finding in a staging CT scan prior to irradiation therapy. However, after the onset of immunosuppressive therapy, an exacerbation of chronic, localized inflammation was expected. Therefore, open surgical anterior rectum resection was performed, and after a short hospital stay, the patient could be discharged home free of complaints. This case report aims to raise awareness of possible long-term complications of hernia repair when using non-absorbable meshes. Keywords Hernia surgery . Mesh migration . Sigmoid perforation . Surgical complications . Transabdominal preperitoneal plastic
Case Report Inguinal hernia repair is one of the most common surgical procedures with estimated 20 million procedures per annum worldwide [1]. In addition to open hernia repair including reinforcement via mesh (e.g., Lichtenstein technique), transabdominal preperitoneal plastic (TAPP) is a widely accepted method for minimally invasive hernia repair. The International Endohernia Society (IEHS) values the latter as effective surgical treatment for inguinal hernia [2]. Open procedure or minimally invasive approach, however, hernia surgery is both easy and safe with a 30-day-mortality comparable with the population-standardized mortality rate and rare wound infections. The most common long-term complications are hernia recurrence, chronic pain, and infertility [3]. All these events are scarce, but very rarely, other complications can arise. This article is part of the Topical Collection on Surgery * Kim R. Liedtke [email protected] 1
Department of General, Visceral, Thoracic and Vascular Surgery, University of Greifswald, Sauerbruchstraße, 17475 Greifswald, Germany
2
Institute of Pathology, University of Greifswald, Friedrich-Loeffler-Straße 23e, 17475 Greifswald, Germany
A 57-year-old patient presented with CT-suspected perforation in the sigmoid colon. However, the patient was in a good condition, and vegetative symptoms were negated. There were no known allergies, and drug ingestion was limited to antihypertensive drugs (i.e., bisoprolol, ramipril, torasemide, pantoprazole, and alendronate). Fourteen years ago, he underwent laparoscopic hernia repair via TAPP, after rapidly progredient inguinal hernia left sided. Intraoperatively, the sigmoid was displaced in the hernial sac (i.e.,
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