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Avoiding migration at open mesh plug inguinal hernioplasty. Heliyon 2022; 8:e09320. [PMID: 35540936 PMCID: PMC9079702 DOI: 10.1016/j.heliyon.2022.e09320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/09/2022] [Accepted: 04/20/2022] [Indexed: 12/05/2022] Open
Abstract
The open repair of groin hernias is often augmented with prosthetic biomaterials (mesh) as this favours a lower recurrence rate. The use of such prostheses may be associated with various complications including migration the frequency of which is unclear. A 29-year review of this complication after mesh plug hernioplasty is undertaken and technical advice described to avoid this.
Open Mesh plug inguinal hernia repair needs to be performed methodically.
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Davidson T, Nissan J, Krichmar M, Lotan E, Shrot S, Gluck I, Lawson P, Yahalom R, Duvdevani S. 18F-FDG PET-CT postoperative changes after maxillectomy: Findings and pitfalls in interpretation. Dentomaxillofac Radiol 2021; 50:20200574. [PMID: 33882254 DOI: 10.1259/dmfr.20200574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE We investigated the findings and pitfalls of FDG-PET/CT scanning after maxillectomy with reconstruction/rehabilitation procedures, in patients with head and neck malignancies treated during nine years at one tertiary medical centre. METHODS Fourteen patients (10 males), aged 22-84 years, underwent 17 reconstruction/rehabilitation maxillectomy surgeries and 35 PET/CT scans. Postoperative PET/CT findings were correlated with clinical and imaging follow-up. RESULTS Increased FDG uptake, mean SUVmax 2.4 ± 1.4 (range 0.3-4.3), was observed at the postoperative bed following 12 of 17 surgeries (71%; 10 obturators, two mesh reconstructions). Following the remaining 5/17 surgeries (three with a fat flap and two without any reconstructions), abnormal FDG uptake was not observed at the postoperative bed.CT features of postoperative sites included: non-homogeneous mixed iso/hyperdense structures (hollow or filled) with multiple surrounding and/or inside air bubbles ("sponge appearance") and mucosal thickening along the postoperative bed wall (in all cases with obturator implants); rich fat density material in reconstructions with a fat flap and in closures without reconstruction, and radiopaque elongated structures in mesh reconstructions.No correlation was found of the mean SUVmax in initial scans, with the time from the surgery date (10 ± 6 months; r=0.04, P=0.90), or with the mean SUVmax in final scans (at 25± 17 months, P=0.17). CONCLUSIONS: Increased FDG uptake, together with corresponding non-specific CT features, may persist for a prolonged period after surgery with obturators and mesh implantations, mimicking malignancy or infection. Awareness of variations in postoperative PET-CT appearance can help avoid false interpretations and redundant invasive procedures.
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Affiliation(s)
- Tima Davidson
- Department of Nuclear Medicine, Chaim Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Johnatan Nissan
- Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel.,Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Maria Krichmar
- Oral and Maxillofacial Surgery, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Eyal Lotan
- Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel.,Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Shai Shrot
- Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel.,Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Iris Gluck
- Department of Oncology, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Paul Lawson
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Ran Yahalom
- Oral and Maxillofacial Surgery, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Shay Duvdevani
- Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel.,Department of Otolaryngology Head and Neck Surgery, Chaim Sheba Medical Center, Tel Hashomer, Israel
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Fajardo R, Diaz F, Cabrera LF, Pedraza M. Acute abdomen in the centanary patient, mesh migration into the sigmoid colon after laparoscopic inguinal hernia repair (TAPP): A case report and review of literature. Int J Surg Case Rep 2020; 66:334-337. [PMID: 31924576 PMCID: PMC7013167 DOI: 10.1016/j.ijscr.2019.11.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 11/16/2019] [Accepted: 11/24/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The complications induced by mesh, such as foreign body reaction, deep-seated infection, mesh migration and perforation into viscera, have been reported sporadically. Colon erosion and penetration by laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair mesh can possibly cause perforation of the colon with acute abdomen. CASE PRESENTATION A 100-year-old male, who underwent 4 years ago TAPP repair of left inguinal, presented to the emergency department with acute abdomen due to chronic mesh penetration into the sigmoid colon, the migrating mesh generated a free wall perforation with generalized fecal peritonitis. DISCUSSION Tailoring the mesh, appropriate suture placement and adherence to principles of antisepsis during hernia repair surgery are crucial in avoiding longterm mesh-related complications. CONCLUSION TAPP is a safe procedure for treat groin hernias, unless, mesh complications like foreign body reaction, deep-seated infection, mesh migration and perforation.
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Affiliation(s)
- Roosevelt Fajardo
- Department of General Surgery, Fundación Santa Fe de Bogotá, Bogota, Colombia
| | - Francisco Diaz
- Department of General Surgery, Fundación Santa Fe de Bogotá, Bogota, Colombia
| | - Luis F Cabrera
- Department of General Surgery, Fundación Santa Fe de Bogotá, Bogota, Colombia; Departmen of General Surgery, Universidad El Bosque, Bogota, Colombia
| | - Mauricio Pedraza
- Departmen of General Surgery, Universidad El Bosque, Bogota, Colombia.
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Liu S, Zhou XX, Li L, Yu MS, Zhang H, Zhong WX, Ji F. Mesh migration into the sigmoid colon after inguinal hernia repair presenting as a colonic polyp: A case report and review of literature. World J Clin Cases 2018; 6:564-569. [PMID: 30397615 PMCID: PMC6212604 DOI: 10.12998/wjcc.v6.i12.564] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 08/17/2018] [Accepted: 08/31/2018] [Indexed: 02/05/2023] Open
Abstract
Mesh migration and penetration into abdominal viscera rarely occur after laparoscopic inguinal hernia repair. We present the first case of mesh migration into the sigmoid colon identified as a colonic polyp at initial colonoscopic examination. The patient complained of mild abdominal distention in the lower abdomen over the previous year without changes in bowel habits or stool appearance and without weight loss. By complementary endoscopic ultrasonography, a cavity-like structure beneath the suspected polyp was further confirmed. Enhanced abdominal computed tomography merely revealed local bowel wall thickening and inflammation of the colosigmoid junction. The migrating mesh, which was lodged in the sigmoid colon and caused intra-abdominal adhesion in the lower abdominal cavity, was finally identified via exploratory surgery. The components of inflammatory granulation tissue around the mesh material were diagnosed based on histological examination of the surgical specimen after sigmoidectomy. In this patient, nonspecific endoscopic and imaging outcomes during clinical work-up led to the diagnostic dilemma of mesh migration. Therefore, the clinical, radiological and endoscopic challenges specific to this case as well as the underlying reasons for mesh migration are discussed in detail.
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Affiliation(s)
- Sha Liu
- Department of Gastroenterology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Xin-Xin Zhou
- Department of Gastroenterology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Lin Li
- Department of Gastroenterology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Mo-Sang Yu
- Department of Gastroenterology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Hong Zhang
- Department of Gastroenterology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Wei-Xiang Zhong
- Department of Pathology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Feng Ji
- Department of Gastroenterology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
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Whitehead-Clarke TI, Smew F, Zaidi A, Pissas D. A mesh masquerading as malignancy: a cancer misdiagnosed. BMJ Case Rep 2018; 2018:bcr-2017-222202. [PMID: 29367220 DOI: 10.1136/bcr-2017-222202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
After a positive faecal occult blood test, a 60-year-old woman underwent a screening colonoscopy which identified a malignant-looking ulcer in the ascending colon. Biopsies from the lesion were inconclusive. A subsequent CT scan of the abdomen and pelvis commented on a polypoid lesion in the ascending colon. A colorectal cancer multidisciplinary team discussion concluded that a right hemicolectomy was indicated as the lesion was suspicious for malignancy. Intraoperatively, there was a firm ascending colon mass adherent to the abdominal wall, which was resected with clear margins. There were no other complications, and the patient was discharged without further issues. Histopathology from the retrieved specimen revealed a complete absence of malignancy, but rather, inflamed granulation tissue with 'reaction to foreign birefringent material'-likely to represent a mesh from an incisional hernia repair 9 years previously. The patient is currently recovering well without complication.
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Affiliation(s)
| | - Farag Smew
- General Surgery, Epsom and St Helier University Hospitals NHS Trust, London, UK
| | - Ahsan Zaidi
- General Surgery, Epsom and St Helier University Hospitals NHS Trust, London, UK
| | - Dimitrios Pissas
- General Surgery, Epsom and St Helier University Hospitals NHS Trust, London, UK
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Eid JJ, Rodriguez A, Radecke JM, Murr MM. An unusual cecal mass on routine colonoscopy. J Surg Case Rep 2014; 2014:rju119. [PMID: 25389130 PMCID: PMC4226926 DOI: 10.1093/jscr/rju119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Cecal masses secondary to extra-luminal compression are rare. We report a case of a 72-year-old man with a cecal mass found during routine colonoscopy with multiple biopsies showing normal colonic mucosa. The patient had a relevant past surgical history of a bilateral open inguinal hernia repair using the 'Plug-and-Patch' mesh system. A computed tomography scan of the abdomen and pelvis showed a 4 × 3.3 cm mass that compressed the wall of the cecum. A neoplastic process could not be ruled out. Diagnostic laparoscopy with intraoperative colonoscopy showed that the right hernia plug was not deployed and was causing extrinsic compression of the anterior cecal wall and an intraluminal impression upon insufflation of the colon. This case report reiterates the importance of combining intraoperative colonoscopy with laparoscopy for diagnosis of undetermined colonic masses.
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Affiliation(s)
- Joseph J Eid
- School of Medicine and Medical Sciences, University of Balamand, Beirut, Lebanon
| | - Ariel Rodriguez
- Department of Surgery, University of South Florida and Tampa General Hospital, Tampa, FL, USA
| | - Jason M Radecke
- Department of Surgery, University of South Florida and Tampa General Hospital, Tampa, FL, USA
| | - Michel M Murr
- Department of Surgery, University of South Florida and Tampa General Hospital, Tampa, FL, USA
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Hernia mesh migration into bladder presenting as malignancy: potential source of diagnostic errors. Hernia 2014; 18:903-6. [DOI: 10.1007/s10029-014-1260-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 04/25/2014] [Indexed: 11/25/2022]
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PET/US fusion as a problem-solving tool in oncology imaging: differentiation of hernia repair mesh plugs from malignancy suspected on PET/CT. Clin Nucl Med 2013; 39:e75-7. [PMID: 23579978 DOI: 10.1097/rlu.0b013e31828164a4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PET/CT is an established modality for evaluation of malignant disease. However, in many cases, specificity is impaired by false-positive findings. Recognition of these cases is crucial for correct diagnosis and subsequent patient management. In the presented case, malignant disease was suspected in a young man because of a history of B symptoms. F-FDG PET/CT showed hypermetabolic foci in both inguinal regions initially classified as possible lymphoma. Using a novel technique for PET/US fusion, ultrasound and PET were coregistered to clarify that PET hypermetabolism was due to a foreign body reaction after plug hernioplasty performed several years earlier.
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Novaretti JPT, Silva RDP, Cotrim CAC, Souto LRM. Migration mesh mimicking bladder malignancy after open inguinal hernia repair. Hernia 2012; 16:467-470. [PMID: 21140183 DOI: 10.1007/s10029-010-0760-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Accepted: 11/21/2010] [Indexed: 02/05/2023]
Abstract
Despite the benefits of using surgical meshes to repair abdominal and inguinal hernias, there are increasing reports of mesh migration into the gastrointestinal and urinary tracts-a complication that cannot be overlooked or neglected. Resolution of such cases can be difficult and depends on the degree of migration and the anatomical site involved. The present paper reports the case of a 68-year-old patient undergoing a trans-ureteral resection of a possible bladder malignancy diagnosed following clinical and radiological evaluation. During the procedure (cytoscopy), it was found that migration of a mesh was mimicking the urological disease initially suspected. A polypropylene mesh had been inserted into the right inguinal region 20 years previously to repair an inguinal hernia. This is one of only a few case reports on mesh migration presenting as a suspected bladder malignancy.
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Affiliation(s)
- J P T Novaretti
- Department of Surgery, School of Medical Sciences, Universidade de Marília (UNIMAR), Av. Rio Branco, 1132-Cj. 41, Marília, SP, CEP 17502-000, Brazil
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