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Intestinal erosions following inguinal hernia repair: a systematic review

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Abstract

Purpose

To sum all available evidence regarding mesh or mesh fixation material intestinal erosion following inguinal hernia repair and identify the parameters that lead to early (< 6 months) versus late (> 6 months) symptom presentation.

Methods

A systematic literature search of the MEDLINE, Scopus and Google Scholar databases was undertaken to identify relevant studies published up to June 2020.

Results

A total of 54 case reports or cases series, incorporating 57 intestinal erosions were identified. Overall, 13 patients (23%) experienced early intestinal erosions occurring during the first 6 postoperative months while the remaining 44 events (67%) occurred after 6 months. Patients presented most commonly with symptoms of acute obstruction (n = 18, 31.5%), followed by signs of a palpable inguinal mass in 15 patients (26.3%). The late presentation group exhibited significantly more cases of mesh erosion when compared to the early presentation group (100% versus 46.2%, respectively, p < 0.001). Conversely, early presenting cases were more often associated with mesh fixation material erosion (53.8% versus 6.8% in the late group, p < 0.001) and were more likely to develop symptoms of acute intestinal obstruction (61.5% versus 22.8%, p = 0.01). An open primary procedure was more common in late presenting cases (65.9% versus 7.7%, p < 0.001) while early presentation was linked to minimally invasive primary procedures (92.3% versus 34.2%, p < 0.001). Bowel resection was more frequently required in late presenting cases (84.1% versus 46.2%, p = 0.009).

Conclusions

Intestinal erosion from prosthetic material is a rare complication of hernia repair leading to considerable morbidity. Prompt operative repair is key in avoiding catastrophic consequences.

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Authors and Affiliations

  1. Third Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, Rimini 1 Str., Chaidari, Athens, 12462, Greece

    Nikolaos Koliakos, Dimitrios Papaconstantinou, Constantinos Nastos, George Kirkilesis, Georgia Bompetsi, Anargyros Bakopoulos, Vasileia Ntomi & Emmanouil Pikoulis

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  1. Nikolaos Koliakos
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Koliakos, N., Papaconstantinou, D., Nastos, C. et al. Intestinal erosions following inguinal hernia repair: a systematic review. Hernia 25, 1137–1145 (2021). https://doi.org/10.1007/s10029-020-02324-1

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