Should Mesh Plug Use Be Discontinued in Hernia Repair Practices?

Abstract

Mesh plugs are commonly used in inguinal hernia repair due to their perceived efficacy in reducing recurrence rates. However, their use has been associated with significant complications, including mesh migration, chronic pain, infection, hernia recurrence, adhesions, and erosion into adjacent organs. This case series presents three patients who experienced complications from mesh plug migration post-hernia repair. The patients, aged 63, 82, and 90, presented with symptoms ranging from chronic pain and groin bulging to acute-onset pain and recurrent hernias. Diagnostic imaging revealed migrated mesh plugs adhered to critical structures such as the spermatic cord and small bowel. The surgical intervention involved robotic-assisted laparoscopic techniques to excise the migrated mesh plugs and place the new mesh in the preperitoneal space. Postoperative outcomes were stable. A review of the literature supports our findings, emphasizing the multifactorial mechanisms behind mesh migration and its severe clinical implications. Given these risks, we recommend generally avoiding the use of mesh plugs in hernia repair, if possible. Instead, other mesh alternatives and improved fixation techniques should be considered to enhance patient outcomes and reduce the incidence of these complications.

Keywords: case series; hernia repair; mesh migration; mesh plug complications; surgical outcomes.

Figure 1. CT of the abdomen and pelvis without contrast (axial view) with recurrent fat-containing left inguinal hernia found in the left anterior pelvis with a 2.7 cm structure consistent with a previous left inguinal hernia repair plug (red box).

Figure 2. Case 1: intraoperative photo showing a migrated mesh plug found adherent to the cord structures.

Figure 3. CT of the abdomen and pelvis without contrast (axial view) showing postsurgical changes noted within the left groin related to a previous inguinal hernia repair and a right inguinal hernia identified containing fat and a small volume of fluid (red box).

Figure 4. Case 2: intraoperative image of mesh plug (red arrow) found crumpled and adherent to the small bowel.

Figure 5. CT of the abdomen and pelvis without contrast (axial view) with a small fat-containing periumbilical hernia in A (red arrow). Panel B shows a small fat-containing left inguinal hernia (green arrow) and a right inguinal hernia containing a loop of the small bowel (blue arrow).