PMC6545489_01
Literature on mesh migration/erosion after ventral (n=2) and incisional hernia repair (n=15)
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T1
After antibiotic pretreatment, re-laparotomy with extirpation of the mesh, adhesiolysis, spare resection of the small bowel including the fistulas, ileo-ileostomy and reconstruction of the abdominal wall was performed in 4/18 (Figure 1 (Fig. 1),
First case. Intraoperative situs of the incised skin with the high output enterocutanous fistula
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F1
Figure 2 (Fig. 2), Figure 3 (Fig. 3)) . From the intraoperative findings it was clear that the mesh eroded the small bowel and caused the fistulas.
Implanted mesh with central enterocutanous fistula
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F2
Figure 2 (Fig. 2), Figure 3 (Fig. 3)) . From the intraoperative findings it was clear that the mesh eroded the small bowel and caused the fistulas.
Figure 3 : En-bloc exzised mesh with the enterocutanous fistula centrally
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F3
After 3 months of intensive wound-therapy, the patient was able to handle the low-output fistula like a small stoma and presented in 10/2018 with complete oral intake and a secretion of less than 5cc per day (Figure 4 (Fig. 4)).
PMC6545489_02
Stable low output entero-cutaneous fistula 24 months after resection of the migrated mesh. No evidence of hernia-recurrence (with written consent of the patient)
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F4
Second case. Enterocutanous fistula with migrated mesh
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F5
An exploratory laparotomy with removal of the mesh and en bloc resection of two segments of the small bowel was performed (Figure 6 (Fig. 6), Figure 7 (Fig. 7), Figure 8 (Fig. 8)).
Intraoperative picture of excision of migrated mesh with fistula
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F6
An exploratory laparotomy with removal of the mesh and en bloc resection of two segments of the small bowel was performed (Figure 6 (Fig. 6), Figure 7 (Fig. 7), Figure 8 (Fig. 8)).
Intraoperative picture of excision of migrated mesh with fistula
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F7
An exploratory laparotomy with removal of the mesh and en bloc resection of two segments of the small bowel was performed (Figure 6 (Fig. 6), Figure 7 (Fig. 7), Figure 8 (Fig. 8)).