Enterocutaneous fistula associated with ePTFE mesh: case report and review of the literature

Abstract

A case of enterocutaneous fistula secondary to the erosion of an expanded polytetrafluoroethylene (ePTFE) prosthesis into the jejunum is described. This case is unusual secondary to the long experience with ePTFE and the lack of published cases similar to this one. The technical details of this case reveal extenuating circumstances associated with the fistula formation, and it is concluded that this particular case does not provide sufficient evidence to implicate ePTFE, by itself, as an etiologic agent for gastrointestinal fistulization. In addition, the published safety record of ePTFE in abdominal wall surgery is reviewed.

Hiatal hernia repair with mesh: a survey of SAGES members

“…For a perspective on this issue, the recurrence rate for inguinal and ventral hernia repair generally has been lower with the use of prosthetic coverage (results not reviewed here); mesh now is commonly employed in the repair of inguinal and ventral defects in many developed countries. Unfortunately, mesh-related complications (e.g., infection, erosion, seroma, pain) have been a trade-off in this paradigm shift of abdominal wall hernia repair [34][35][36][37][38]. Mesh-related complications also afflict prosthesis-reinforced repair of the hiatal defect [27][28][29][30]39].…”

“…Moreover, it appears that the use of PTFE was associated with a small but defined incidence of erosion and stricture at the esophageal hiatus. Until recently, PTFE (i.e., expanded PTFE [ePTFE]) was assumed to have benign behavior when apposed to hollow viscera [27,29,30,37,38].…”

Use of porcine small intestine submucosa as a prosthetic material for laparoscopic hernia repair in infected and potentially contaminated fields: long-term follow up assessment; Surg Endosc (2008) 22: 1941–1946

“…This is an important fact that should have been made known to the readers. Second, ePTFE has been abandoned for the described reason by many surgeons in the past 15 years, and a great body of recent literature exists on this issue that is missing in this work [4][5][6].…”

Laparoscopic Transabdominal Preperitoneal Repair of Ventral Hernia: A Step Towards Physiological Repair

“…However, laparoscopic intraperitoneal placement of prosthetic mesh is associated with adhesion formation, bowel obstruction and enterocutaneous fistula. These complications are more common with polypropylene mesh and are statistically significant when compared with expanded polytetrafluoroethylene (ePTFE) [4,9] or barrier meshes [10]. Using a barrier mesh, instead of polypropylene mesh, lowers these risks, but increases the cost of the procedure considerably.…”