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Session: ePoster: Benign Abdominal 10 (Tue8)

EP903 - Low Anterior Resection for Mesh Erosion After inguinal Hernia Repair

Tuesday, May 13, 2025
8:21 AM – 8:26 AM PT

    ePoster Presenter(s)

  • MG

    Martin Gutman, M.D.

    Resident Physician
    University of Miami/HCA JFK Hospital
    University of Miami
    Boca Raton, Florida, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • Eric Johnson, MD

    General Surgery Resident
    University of Miami/HCA
    West Palm Beach, FL, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

  • JR

    Juliet Ray, MD

    Colorectal Surgeon
    HCA
    Atlantis, Florida, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

  • HB

    Heidi Bahna, MD

    Colorectal Surgeon/PD
    HCA/ university of Miami
    Atlantis, Florida, United States

    Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.
Martin Gutman, M.D.: This individual has no financial relationships with ineligible companies.
Eric Johnson, MD: This individual has no financial relationships with ineligible companies.
Juliet Ray, MD: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: Inguinal hernia repair is one of the most commonly performed elective surgeries in the United States. Surgical techniques have continued to develop, with robotic inguinal hernia repair becoming more prevalent as it is generally well-tolerated. The most widely utilized repair includes an underlay mesh with closure of the peritoneal flap. Despite its low complication rate, long-term complications including mesh migration, erosion into adjacent structures, enterocutaneous fistula formation, and abscess formation, are well documented. Erosion into abdominal structures is rare when the peritoneal flap is adequately closed. In this care report we describe a case of mesh erosion into the sigmoid colon discovered during screening colonoscopy.

Methods/Interventions: A 77-year-old male presented 1-year post-operatively from a robotic left inguinal hernia repair with underlay mesh for a sliding left indirect hernia containing sigmoid colon. He presented for screening colonoscopy and was found to have a suspected sigmoid mass that was biopsied and tattooed. Pathology showed inflammatory tissue without adenomatous features or malignancy. He was subsequently referred to colorectal surgery and a colonoscopy was repeated, revealing a surgical mesh that had eroded through the colonic wall into the lumen with associated granulation tissue at the tattoo site. CT imaging confirmed inguinal repair mesh erosion through the peritoneum and into the sigmoid colon. The patient was consented and later presented to the hospital for elective robotic low anterior resection.

Results/Outcomes: Upon entry to the abdominal cavity, the sigmoid colon was found to be adhered to the left lower quadrant peritoneum. The anterolateral corner of the mesh had eroded through the peritoneum and into the antimesenteric sigmoid colon with associated chronic inflammation and abscess. The section of mesh was transected at the level of the peritoneum ensuring no further mesh fibers were exposed and the affected portion of bowel was resected. An end-to-end anastomosis of the descending colon and rectum was performed with EEA stapler. Perfusion was confirmed with ICG angiography. The patient recovered well with no further complications.

Conclusion/Discussion: Although the use of surgical mesh improves the recurrence rate of inguinal hernias, it is not without risk. Mesh erosion should be considered as possible etiology in post-operative patients with chronic abdominal symptoms. Mesh erosion can be effectively treated with surgical resection of the affected colon and involved mesh. Research into discrepancies in surgical technique for inguinal hernia repair could yield fewer cases of mesh erosion and its associated complications.