Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

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S. Towfigh
in addressing her symptoms or she developed intolerances to them, such
as nausea, vomiting, and dizziness. Evaluation by gynecology and further
imaging demonstrated no suggestion of recurrence of her
endometriosis.
Due to the direct relationship between the hernia repair with mesh
and her debilitated state at such a young age, she was offered laparoscopic
mesh removal. She understood that this might not cure her of her
problem and that indeed there was no concrete diagnosis. Also, she
understood the risks of the procedure, which included the risk of nerve
injury and vessel injury at the time of mesh removal. She underwent
uneventful laparoscopic mesh removal bilaterally. No hernias were
noted after mesh removal.
Postoperative Course and Outcomes
In anticipation of a difficult postoperative course, she had an epidural
placed preoperatively. This allowed for smooth recovery postoperatively.
She had shown sensitivity to many different pain medications and
was able to tolerate pain control with ice and acetaminophen. Pathology
of the mesh demonstrated dense fibrosis and chronic inflammation with
foreign body giant cell reaction . Over a span of 1 year, she was able to
recuperate toward a more normal life. Repeat MRI confirmed no hernia
recurrence. She is now eating and gaining weight. Her hair loss has
stopped. She is regaining her conditioning with physical therapy.
Discussion
It is unpredictable which patients may develop a mesh reaction . A
true mesh allergy is notable as an erythematous blotch on the skin, usually
demarcating the exact dimensions of the mesh itself. There may be
associated edema or systemic reaction such as fever. Such a mesh
allergy is rare and few surgeons have witnessed it.
However, there does seem to be another reaction to mesh, specifically
to synthetic mesh, which is a foreign body reaction . To date, there is no
literature to support such a clinical problem and its presentation; however,
we know that histologically this reaction does occur [ 1 ]. Also,
clinically, it has been shown very nicely that positron emission tomography
(PET) scan may be positive in patients with mesh implantation,
demonstrating the inflammatory response to synthetic mesh [ 2 ].