Mind the gap: imaging spectrum of abdominal ventral hernia repair complications

Abstract

Ventral hernia repair with or without mesh placement is a commonly done procedure. Laparoscopic approach is more preferred than open in recent surgical practice. Complications occur as like any other abdominal surgeries and are dependent on multiple factors. Complications such as collections, adhesions, and related changes are non-specific. Specific complications related to hernia repair include recurrent hernia, mesh infection, mesh migration, and fistula formation. Post inguinal hernia repair chronic inguinal pain is gaining more attention with increasing use of image-guided nerve interventions for symptomatic management. Imaging plays a vital role in defining and delineating the type and extent of complications. Prior knowledge of the surgical indication and technique helps in better imaging interpretation of complications. This article describes the role of imaging in diagnosis of complications in general ventral hernia surgery setting.

Spontaneous Migration of Intraperitoneal Mesh into Rectum following Ventral Hernia Repair

“…Erosion into the bowel and urinary bladder are described. 4,5 Migration into the bowel can cause complications such as obstruction, infection, or fistula formation. 4 There is mixed hypothesis on the exact predisposing factors of mesh erosion and migration and commonly include subclinical infection and foreign body reaction.…”

“…4,5 Migration into the bowel can cause complications such as obstruction, infection, or fistula formation. 4 There is mixed hypothesis on the exact predisposing factors of mesh erosion and migration and commonly include subclinical infection and foreign body reaction. 6 In an experimental study by Wattanasirichaigoon, 7 a surgical sponge was retained in various positions in the abdomen of rats, and migration of the sponge into bowel lumen was found without a hint of infection possibly suggesting a dominant low-grade foreign body reaction.…”

“…The progressive migration of the mesh ball on CT is depicted in ►Fig. 4 The mesh ball was removed with intact sutures from the rectum under anesthesia (►Fig. 5).…”

Relatório DECOMP: Respostas que os cirurgiões esperam de um exame de imagem da parede abdominal

“…Exames de imagem podem determinar o tamanho e o conteúdo da hérnia, o volume do saco herniário, a proximidade da hérnia com estruturas ósseas ou mesmo atrofia muscular associada. Tais exames orientam a necessidade de medidas pré-operatórias ou intraoperatórias para aumentar a complacência/volume da cavidade abdominal, definem o tamanho aproximado, a melhor posição para a tela e seus métodos de fixação, além de sugerirem riscos perioperatórios e resultados pós-operatórios [2][3][4] .…”

Transmural Mesh Migration From the Abdominal Wall to the Rectum After Hernia Repair Using a Prolene Mesh: A Case Report

“…Mesh repair enables tension-free repair and reduces the overall recurrence rate compared to that of primary repair [ 2 ]. Despite its advantages, complications including seroma, mesh infection, fistula formation, erosion, and migration occur infrequently [ 3 ]. Mesh migration is very rare and difficult to diagnosis because of its broad spectrum of clinical presentation.…”