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Case Reports
. 2024 Nov 22;16(11):e74204.
doi: 10.7759/cureus.74204. eCollection 2024 Nov.

Should Mesh Plug Use Be Discontinued in Hernia Repair Practices?

Mena Louis  1 , Nathaniel Grabill  1 , Jerrell Fang  1 , Oluwasemilore Okunlola  1 , James Chambers  2
Affiliations
Case Reports

Should Mesh Plug Use Be Discontinued in Hernia Repair Practices?

Mena Louis et al. Cureus. .

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.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
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
Figure 2. Case 1: intraoperative photo showing a migrated mesh plug found adherent to the cord structures.
Figure 3
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
Figure 4. Case 2: intraoperative image of mesh plug (red arrow) found crumpled and adherent to the small bowel.
Figure 5
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).
See this image and copyright information in PMC

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