Laparoscopic Removal of an Infected Mesh Following TEP Procedure for Femoral Hernia with Omental Patch Closure of a Peritoneal Defect

Patient: Female, 76-year-old Final Diagnosis: Mesh infection following femoral hernia repair Symptoms: Pain • redness • swelling Clinical Procedure: Laparoscopic surgery Specialty: Surgery OBJECTIVE: Unusual clinical course BACKGROUND: Mesh infection following inguinal hernia repair is rare, and mesh removal is mandatory. However, the laparoscopic approach is challenging to perform. Here, we present a case of laparoscopic repair of a mesh infection using a totally extraperitoneal approach (TEP). CASE REPORT: A 76-year-old woman underwent repair of a right femoral hernia via TEP approach using a prosthetic mesh with unabsorbable tacks. A month and a half after the surgery, she reported pain in the right groin. Computed tomography revealed a subcutaneous abscess in the right groin. We suspected mesh infection and initially chose conservative management, which included percutaneous drainage and systemic antibiotic administration. Her symptoms temporarily resolved; however, symptom relapse and purulent discharge from the right groin were observed. We performed laparoscopic removal of the infected mesh and all tacks via the transabdominal preperitoneal approach. A drain was placed in the infected preperitoneal space, and the peritoneal defect was covered using the greater omentum. The patient’s postoperative course was uneventful, and she was discharged on postoperative day 20. Infection relapse, symptoms of femoral hernia, and adhesive intestinal obstruction have not been observed. CONCLUSIONS: A laparoscopic approach for mesh infection after TEP hernia repair is feasible, even if the mesh is fixed using a tack. Greater omental use for peritoneal defects is useful in clinical situations associated with a contaminated surgical field.