Mesh-related visceral complications following inguinal hernia repair. An emerging topic

The use of meshes in inguinal hernia repair (IHR) has gained popularity but new complications have been observed. Meshrelated visceral complications (MRVCs) are generally considered rare and hence are not studied in depth. We carried out a thorough literature search and collected 101 clinical reports published from 1992 to 2018. The reported complications seem to have tripled in the last decade. Ninety-seven cases met the inclusion criteria and they were subdivided into four groups (group A—onlay IHR, group B—3-D IHR, group C—preperitoneal IHR, group D—laparoscopic IHR) to be analyzed, according to the herniorraphy technique. Every prosthetic IHR can be followed by MRVCs but, according to the present review, the highest incidence is related to laparoscopic repairs, the lowest to Lichtenstein technique. Time-to-event was shorter in case of preperitoneal position of the prosthesis than when the mesh was implanted over the transversalis fascia. Urinary bladder involvement predominantly occurred after laparosopic IHR. A pathogenic correlation between the most frequently complained clinical signs and the previous mesh herniorraphy was rarely reported. The diagnosis was generally made at laparotomy, which was usually performed as an emergency. Removing the infected mesh and resecting or suture repairing the involved viscera was the challenging surgical treatment. Prevention of MRVCs after inguinal hernia repair appears to be an important significant issue. It is important to pay attention to the choice of a proper implantation site, avoiding direct contact between the mesh and viscera, and to select a proper device. Keywords Mesh migration · Mesh erosion · Mesh-related visceral complications · Inguinal hernia repair Introduction Inguinal hernia repair (IHR) is the most frequently performed operation in general surgery. Each year more than 20 million inguinal hernia repairs are performed worldwide. Since tension-free open IHR has strongly been promoted by Lichtenstein, prosthetic IHR has gained popularity and has significantly reduced recurrence. The European Guidelines, in fact, state that all male adults over the age of 30 with a symptomatic groin hernia should be operated using a mesh-based technique (grade of recommendation-A) [1, 2]. Although the onlay placement of a flat mesh, as described by Lichtenstein, is still recommended as standard operation for groin hernia repair, many new meshes and surgical variants have developed over the years, including 3-D devices and laparoscopic IHR. Basically, all mesh techniques have reported comparable outcomes, in terms of total morbidity, chronic pain, and recurrence [3–5]. As a result, the choice of the most suitable groin hernia repair should be based on surgeon expertise, patient and hernia-related factors, and local/national resources [1, 2]. In the past years, early operative technique-related visceral complications such as urinary bladder/bowel injuries and/or intestinal obstruction, have been considered to occur more frequently in cases of laparoscopic than open repairs [6, 7]. This difference has been now cancelled, due to the standardization of laparoscopic techniques. Mesh-related visceral complications (MRVCs) following IHR, that can occur when the mesh comes in contact with the intra-abdominal organs, have been less investigated. Electronic supplementary material The online version of this article (https ://doi.org/10.1007/s1002 9-019-01905 -z) contains supplementary material, which is available to authorized users. * F. Gossetti gossetti@tiscalinet.it 1 Department of Surgery “Paride Stefanini”, Sapienza University of