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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C.G. DuCoin and G.R. Jacobsen
Operative time was 65 min. The patient was discharged home from
the postoperative unit. He reported near- immediate improvement of his
preoperative chronic pain and was off from all narcotic pain medications
by his 2-week follow- up appointment.
Outcomes and Complications
There is at least a single case report of mesh migration for every type
of hernia repair, both open and laparoscopic. However, there is an exceedingly
greater number of mesh migrations reported for the mesh plug
repairs than for flat mesh repairs [ 1 –6 ]. The location of migration and the
organs involved determine the symptoms produced. Reported locations of
mesh migration include the scrotum, bladder, and hollow viscous structures
such as the cecum and small bowel [ 1 –6 ]. The symptoms produced
include chronic pain, recurrent urinary tract infections, intestinal obstructions,
volvulus, and even intestinal perforation [ 1 –6 ]. One underlying
similarity of these reports is that of lack of mesh fixation or fixation of
original mesh with absorbable suture [ 7 ]. In the end, this patient’s pain
was relieved by removal of the plug and reinforcement of the myopectineal
orifice with a flat sheet of mesh. The authors remain skeptical that the
addition of a mesh plug to a standard Lichtenstein herniorrhaphy provides
any benefit and, at worst, can result in the above complication.
References
1. Chuback JA, Singh RS, Sills C, Dick LS. Small bowel obstruction resulting from mesh
plug migration after open inguinal hernia repair. Surgery. 2000;127(4):475–6.
2. Benedetti M, Albertario S, Niebel T, Bianchi C, Tinozzi FP, Moglia P, et al. Intestinal
perforation as a long-term complication of plug and mesh inguinal hernioplasty: case
report. Hernia. 2005;9(1):93–5.
3. LeBlanc KA. Complications associated with the plug-and-patch method of inguinal herniorrhaphy.
Hernia. 2001;5(3):135–8.
4. Tokunaga Y, Tokuka A, Ohsumi K. Sigmoid colon diverticulosis adherent to mesh plug
migration after open inguinal hernia repair. Curr Surg. 2001;58(5):493–4.
5. Moorman ML, Price DP. Migrating mesh plug: complication of a well-established
hernia repair technique. Am Surg. 2004;70(4):298–9.
6. Nowak DD, Chin AC, Singer MA, Helton WS. Large scrotal hernia: a complicated case
of mesh migration, ascites, and bowel strangulation. Hernia. 2005;9(1):96–9.
7. Jeans S, William G, Stephenson B. Migration after open mesh plug inguinal hernioplasty:
a review of the literature. Am Surg. 2007;73(3):207–9.