Serious life-threatening complication 5 years after laparoscopic totally extraperitoneal hernia repair: case report and discussion of the literature.
OBJECTIVE
The purpose of this paper is to report the case of a serious life-threatening infection of the mesh occurring 5 years after totally extraperitoneal (TEP) hernia repair and to highlight the persistent risk of infection that may exist even after a long period following the primary repair. We also aim to raise the awareness of surgeons to the subtle presentation.


METHODS
We have reviewed the clinical presentation, past medical history and relevant pre-operative and post-operative investigations in a case of mesh infection 5 years after primary surgery. We have also reviewed the literature regarding long-term complications that may occur after TEP repair.


RESULTS
A 62-year-old man presented with severe mesh infection 5 years and 4 months after primary bilateral TEP hernia repair. He rapidly progressed into septic shock and had to be managed in the intensive care unit. He is a current smoker of 30 pack years. Post-operative contrast computed tomography (CT) revealed previously undiagnosed diverticuli scattered throughout the colon with points of minor narrowing at the sigmoid and transverse colons.


CONCLUSIONS
Although the risk of mesh infection following TEP hernia repair is small, it persists for more than 5 years and probably as long as the mesh remains in the body. Our report also raises the question as to whether there is a specific long-term risk of mesh infection following TEP hernia repair in patients with underlying inflammatory bowel disease and/or chronic heavy smoking. This needs to be studied prospectively.
Department of Surgery, Frimley Park Hospital NHS Foundation Trust, Frimley, Camberley, Surrey, GU16 7UJ, UK. igukas@hotmail.com
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Massouh
D018784:Abdominal Abscess / Q000382:microbiology*; D043963:Diverticulosis, Colonic / Q000150:complications; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure / Q000009:adverse effects; D013290:Streptococcal Infections / Q000382:microbiology*; D013291:Streptococcus; D013526:Surgical Mesh / Q000009:adverse effects* / Q000382:microbiology*; D013997:Time Factors