PMC5714852_01
(A) Tacks for closure of the peritoneum. (B) Counterclockwise unscrewing of tacks.
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F1
During laparoscopic revision of the surgical area, three tacks used for closure of the peritoneum were identified (Figure 1A). These were easily gripped by the head and removed by unscrewing counterclockwise (Figure 1B).
(A) Detection of other tacks, used for fixation of upper margin of the mesh, and of a turned-up lower mesh margin. (B) Search for tacks at the pectineal line of the pubic bone and symphysis. (C) Mesh withdrawal after removal of tacks.
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F2
After folding down the peritoneum, other metallic tacks, used for mesh fixation at the upper margin of the mesh, were located (Figure 2A). Through further dissection, it was possible to locate and remove the tacks in the region of the pectineal line of the pubic bone and symphysis (Figure 2B). After removal of all tacks, it was then possible to withdraw the mesh, because the macroscopic appearance was not satisfying and there is no clear recommendation in the literature (Figure 2C).
(A) Correct placement of new mesh (TiMesh light), fixation with fibrin glue and placement of a drain. (B) Closure of peritoneum with a V-lock suture.
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F3
Next, further dissection was carried out in the critical areas, a new mesh (TiMesh light, pfm medical, Cologne) was properly inserted, fixed with fibrin glue, and a drain placed (Figure 3A). Then, the peritoneum was closed with a continuous V-lock suture (Medtronic, Meerbusch) and blocking PDS clip (Figure 3B).