Late rejection of the mesh after laparoscopic hernia repair

Abstract

We report the first case of late rejection of a mesh after laparoscopic hernia repair. It occurred in a 48-year-old man who had had a laparoscopic hernia repair by transabdominal preperitoneal approach 3 years earlier. The most characteristic finding was the slow development of a firm mass in the right groin, without pain or fistula. At admission 3 months later, US and CT scans demonstrated a necrotic mass extending into both iliac fossa. The mass was approached through a midline incision. Pus was taken for microscopic examination (negative), and the mesh was removed, along with several staples. Ultramicroscopic examination of the mesh showed breakdown of the fibers, collagen reduction, and no chronic inflammatory cells. No infectious cause of inflammation was identified.

Prolene–Monocryl-composite meshes do not increase microvascular Staphylococcus aureus adherence and do not sensitize for leukocytic inflammation

“…On the other hand, the contamination of a surgical mesh may also be induced endogenously, as previously reported for the hematogenous infection of joint prostheses from chronic skin lesions [30]. This way of infection may be supported by the fact that the inflammatory granulation tissue surrounding a mesh implant is considered to be more susceptible to the invasion of bacteria than physiological tissue [13,16]. Therefore, the aim of our present in vivo study was to analyze the interaction of circulating bacteria with implanted meshes.…”

“…In fact, mesh repair is characterized by the development of chronic inflammatory tissue surrounding the mesh fibers [15]. As with all inflammatory tissue, this granulation tissue is prone to the invasion of bacteria [13,16]. Whether this process is supported by the implanted biomaterial itself, stimulating the interaction of bacteria with the microvascular endothelium of blood vessels located at the implantation site, has not been investigated so far.…”

Relaparoscopy as an alternative to laparotomy for laparoscopic complications

“…Darüber hinaus gibt es Berichte über erfolgreiche Relaparoskopien bei Dünndarm-obstruktionen nach laparoskopischer Hernioplastik [14]. Extrem selten vorkommende Netzabstoßungen wurden allerdings über eine offene Netzexplantation beherrscht [19].…”

Trevira mesh: a promising new implant for the treatment of abdominal hernias

“…The majority of the implant meshes are made of polypropylene (Prolene, Marlex, Surgipro), which -despite good overall clinical results -has caused problems. Sporadic mesh rejections [4,5,6] have been observed, as well as adhesions and fistulae in cases of direct contact between implant and bowel. The main problem seems to be an inevitable chronic foreign body reaction to the implant material, leading to the phenomena of material hardening and shrinkage of the mesh, with consequent pain, restricted mobility, and recurrent herniation [7,8,9,10].…”