Manish Kumar Gupta, Associate Professor, Sarrah Idrees, Dr, Rathindra Sarangi, Dr. Sir Ganga Ram Hospital, New Delhi
Introduction: Introduction of synthetic mesh was a landmark step forward in the management of hernia repair and has significantly reduced recurrence rates. But in addition to the benefits, some more problems have come in picture like ‘mesh infection and mesh erosion in bowel’. This phenomenon especially after laparoscopic surgeries gives rise to chronic discharging sinus at the port site, abscess formation around mesh and even sepsis. It appears that laparoscopic hernia repair is a promising method but having chances of mesh infection owing to difficult approach and lack of uniformity in sterilization.
Case report: A 64 years normotensive, non-diabetic gentleman presented to us in the out-patient department with the complaints of pus discharging opening in the right groin region for 8 months. He underwent open herniorraphy for right inguinal hernia two and half years back. He developed recurrence of hernia after 1 years of herniorraphy for which he underwent totally extraperitoneal (TEP) repair of inguinal hernia. He remained asymptomatic for few months and subsequently developed pus discharging opening in the right groin with reducible swelling at the same site for which he presented in our OPD.
On local examination, there was a sinus opening in the right inguinal region just above the midpoint of the inguinal ligament with active pus discharge. A visible cough impulse or recurrent right inguinal hernia was also noted.
MRI revealed an organized area of inflammation beneath the anterior abdominal wall in the right iliac fossa of 1.9 x 2.2 cm with adjoining ileal loops. Decision for exploration of sinus with explantation of mesh and need for diagnostic laparoscopy was taken. A 3 cm tract was extending up to the abscess cavity which was present over the mesh. The sinus tract was exposed and abscess cavity was drained. The infected mesh was also removed and enteric content was noted coming out through an opening at the base of the mesh. On diagnostic laparoscopy, there was an ileal loop which was densely adherent to the right inguinal region. The fistulous opening was freshened and enterotomy was closed intracorporeally with vicryl 3-0 in two layers. The muscle defect was repaired with vicryl 2-0 and the right inguinal wound was left open for healing by secondary intention. After 6 months, he underwent hernioplasty by “555 Manish Technique” using all 5 mm ports. On 1st and 6th month of follow up visits, patient was asymptomatic and showed no recurrent hernia.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94976
Program Number: P537
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster