Fig. 37.1.
Laparoscopic preperitoneal view of right groin. Mesh plug found deep to internal ring, overlying and densely encompassing the spermatic cord structures. Mesh plug is medial; spermatic cord is lateral. Spermatic cord lipoma noted laterally.
Operative time was 65 min. The patient was discharged home from the postoperative unit. He reported near-immediate improvement of his preoperative chronic pain and was off from all narcotic pain medications by his 2-week follow-up appointment.
Outcomes and Complications
There is at least a single case report of mesh migration for every type of hernia repair, both open and laparoscopic. However, there is an exceedingly greater number of mesh migrations reported for the mesh plug repairs than for flat mesh repairs [1–6]. The location of migration and the organs involved determine the symptoms produced. Reported locations of mesh migration include the scrotum, bladder, and hollow viscous structures such as the cecum and small bowel [1–6]. The symptoms produced include chronic pain, recurrent urinary tract infections, intestinal obstructions, volvulus, and even intestinal perforation [1–6]. One underlying similarity of these reports is that of lack of mesh fixation or fixation of original mesh with absorbable suture [7]. In the end, this patient’s pain was relieved by removal of the plug and reinforcement of the myopectineal orifice with a flat sheet of mesh. The authors remain skeptical that the addition of a mesh plug to a standard Lichtenstein herniorrhaphy provides any benefit and, at worst, can result in the above complication.