Haniee Chung, Roheena Panni, Nicholas Vryhof, Arghavan Salles, Elisa Birnbaum, Jeffrey Blatnik. Washington University in St Louis
The use of synthetic mesh in the intraperitoneal position to reinforce the repair of abdominal wall defects has become a commonly accepted practice in modern surgery. Specifically, numerous commercially available meshes are designed with anti-adhesive barriers to be used in such position. However, the introduction of a foreign body into the peritoneal cavity is not without potential risk. A rare complication involves erosion of the mesh into a hollow viscus such as the bowel. Patients may be asymptomatic, but often symptoms of abdominal pain, obstruction, infection, or fistulas may severely impact quality of life.
Within a span of four months, three patients presented to our institution for clinical symptoms related to erosion of synthetic mesh into the intraluminal position from prior abdominal hernia repairs. The first patient had a remote history of stage IV rectal cancer and intraperitoneal mesh plug placement for the treatment of an obturator hernia. He then presented with an enterovesical fistula and bowel obstruction. The second patient presented with a liver abscess as a sequela of mesh infection and a chronic intraabdominal abscess from mesh erosion into small bowel from prior repairs. The third patient had a history of a parastomal hernia repair with intraperitoneal synthetic mesh and presented with obstructive symptoms.
This series of patients, while small, occurred in a short span of time, highlighting the increasing clinical prevalence and significance of complications from intraperitoneal placement of synthetic mesh. Numerous patient and technical factors may contribute to the occurrence of this rare complication. We propose avoiding the use of intraperitoneal mesh when possible. Specifically, we advocate the use of lightweight mesh in the preperitoneal or retromuscular to minimize the risk of mesh-related complications.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 77782
Program Number: P160
Presentation Session: Poster (Non CME)
Presentation Type: Poster