Objective To investigate the clinical efficacy of laparoscopic mesh removal combined with bladder repair for the treatment of mesh erosion into the urinary bladder after inguinal hernia repair.
Methods The retrospective and descriptive study was conduc-ted. The clinical data of 13 patients with mesh erosion into the urinary bladder after laparoscopic inguinal hernia repair who were admitted to The Sixth Affiliated Hospital of Sun Yat‑sen University from January 2019 to December 2024 were collected. There were 12 males and 1 female, aged 53.5(range, 27.0-73.0)years. Observation indicators: (1) intraoperative conditions; (2) postoperative conditions; (3) follow‑up. Measurement data with skewed distribution were expressed using the M(range). Count data were expressed as absolute numbers.
Results (1) Intraoperative conditions: all 13 patients underwent laparoscopic mesh removal combined with bladder repair successfully, without conversion to open surgery. The operation time of 13 patients was 208.5(range, 97.0-376.0) minutes, and the volume of intraoperative blood loss was 54.6(range, 10.0-200.0) mL. Complete mesh removal was achieved in all patients during the operation, with mesh located on the left side in 3 cases, on the right side in 8 cases, and bilaterally in 2 cases. Bladder defects were repaired by primary suture in all cases, and no patient required ureteral reimplantation. Intraoperative seromuscular injury of the intestine occurred in 3 cases during adhesiolysis, and the injuries were repaired by suture. No ureteral or iliac vascular injury occurred intraoperatively. Three patients who underwent preoperative temporary ureteral stent placement had the stents removed after surgery. Complete peritoneal closure with placement of a preperitoneal drain was performed in 9 patients, while the remaining 4 patients had the peritoneal defect left open without closure. (2) Postoperative conditions: total duration of hospital stay of the 13 patients was 18.4(range, 8.0-42.0) days. Time to abdominal drainage tube removal of the 13 patients was 4.5(range, 2.0-7.0) days postoperatively. Among them, the 9 patients with pre-peritoneal drainage tube had the tube removed at 5.6(range, 3.0-8.0) days postoperatively. (3) Follow‑up: all 13 patients were followed up for 14.1(range, 6.0-24.0) months. At 1 month post-operatively, 11 patients underwent cystography, which confirmed no urine leakage, and their urinary catheters were removed. The remaining 2 patients were confirmed urine leakage by cystography and retained the indwelling urinary catheter. The 2 patients underwent repeat cystography at 2 months postoperatively, which confirmed no urine leakage, and the catheters were then removed. During the follow‑up period, one patient developed inflammatory ileus, which was resolved after conservative treatment. Three patients developed bladder irritation symptoms, which were resolved after one week of oral antibiotic therapy. One patient experienced recurrence of inguinal hernia at 12 months postoperatively and underwent Lichtenstein repair without further recurrence. No bladder stone, residual infection, or recurrent infection occurred, and no complication ≥Clavien‑Dindo grade Ⅲ were observed in 13 patients.
Conclusion Laparoscopic mesh removal combined with bladder repair can be used for the treatment of mesh erosion into the urinary bladder after inguinal hernia repair.
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