Hernia | 2021
Comment to: intestinal erosions following inguinal hernia repair—a systematic review. Author’s reply
Abstract
We appreciate the interest of D’Amore et al. in our recent publication “Intestinal erosions following inguinal hernia repair: a systematic review” [1]. We concur that meshrelated visceral complications (MRVCs) are an emerging topic and we are of the opinion that it should be brought to the attention of practicing surgeons as a potentially significant source of morbidity following inguinal hernia repairs. As pointed out initially by Gosseti et al. [2], the characteristics of the primary hernia repair are key in the risk for developing MRVC. Due to the scarcity of reported data on the topic, it is uncertain whether the risk is inherent with particular types of hernia operations or whether it can mitigated by altering specific aspects pertaining to the index inguinal hernia operation. Our results differ slightly from those published by Gosseti et al. [2] due differences in inclusion/exclusion criteria and search algorithm, however, our conclusions align, pointing out that early (< 6 months postoperatively) presentation of MRVC is more likely after minimally invasive surgery, while a greater period of latency is expected after open repairs. D’amore et al. [3] postulate that mesh proximity to the peritoneum (as is the case in laparoscopic hernia repairs) is the primary explanation underlying the early emergence of MRVCs. Although, we do not disagree with this fact may indeed play a role, we are unsure whether it is central in the pathophysiologic process leading to MRVCs. In our analysis, we observed that intestinal erosions following plug-and-patch repairs, whereby a prosthetic mesh material is placed inside the internal ring and hence in a closely similar preperitoneal position as in laparocopic cases, exhibited exclusively delayed presentations. Taking this into account, we agree with D’Amore et al. that mesh erosions are a complicated phenomenon; however, we strongly believe that adhering to proper surgical technique and ensuring adequate coverage of the mesh with a peritoneal interface, using as few fixating materials as possible, can at the very least attenuate the risk for early intestinal erosions after minimally invasive inguinal hernia surgery. Finally, we opine that reporting of MRVCs should strongly be encouraged under a common, standardized, reporting frame to ensure that further potentially modifiable risk factors are identified.