Re- appraisal of application of mesh in hernia surgery.

Abstract

Objective: Evaluation of mesh associated complications and reviewing its selective application in hernia surgery. Design: Descriptive study. Setting: Department of Surgery, Fauji Foundation Hospital, Rawalpindi. Period: Jan 2019 – June 2022. Material & Methods: Patients having undergone hernia surgery in past with mesh repair at FFH or any other hospital that had developed complications and reported to surgical unit 1 FFH. Patients of hernia surgery without mesh repair were excluded. Results: A total of 50 cases were included in the study. Majority of patients were females 42(84%). Paraumbilical hernia 18(36%), Epigastric hernia 13(26%), Incisional hernia 12(24%) and Inguinal hernia 7(14%) cases were included in study. Chronic discharging sinus 16(32%), Recurrent acute local sepsis 12(24%), Large painful seroma 5(10%), Recurrent hernia 13(26%), Acute fulminant sepsis after primary surgery 2(4%) and intestinal obstruction 2(4%) were the mesh associated complications present in patients. Majority of the patient required hospitalization and delayed removal of mesh [43 cases] (86%]. Early removal of mesh was required in 2(4%) cases. The residual defect after the removal of mesh was managed by Component separation and slide method: Early in 2(4%) cases and delayed in 17(34%), double breasting of facial sheath 10(20%), double breasting of external oblique with exteriorization of cord 6(12%) cases. Wound toilet and symptomatic treatment without removal of mesh was advised in 3(6%) cases. Emergency laparotomy and gut anastomosis was performed in 2(4%) cases. Conclusion: Indiscriminate use of mesh needs to be checked, as a significant number of patients develop mesh related complications.