Intestinal erosions following inguinal hernia repair: a systematic review.

Purpose: To sum all available evidence regarding mesh or mesh fixation material intestinal erosion following inguinal hernia repair and identify the parameters that lead to early (< 6 months) versus late (> 6 months) symptom presentation.

Methods: A systematic literature search of the MEDLINE, Scopus and Google Scholar databases was undertaken to identify relevant studies published up to June 2020.

Results: A total of 54 case reports or cases series, incorporating 57 intestinal erosions were identified. Overall, 13 patients (23%) experienced early intestinal erosions occurring during the first 6 postoperative months while the remaining 44 events (67%) occurred after 6 months. Patients presented most commonly with symptoms of acute obstruction (n = 18, 31.5%), followed by signs of a palpable inguinal mass in 15 patients (26.3%). The late presentation group exhibited significantly more cases of mesh erosion when compared to the early presentation group (100% versus 46.2%, respectively, p < 0.001). Conversely, early presenting cases were more often associated with mesh fixation material erosion (53.8% versus 6.8% in the late group, p < 0.001) and were more likely to develop symptoms of acute intestinal obstruction (61.5% versus 22.8%, p = 0.01). An open primary procedure was more common in late presenting cases (65.9% versus 7.7%, p < 0.001) while early presentation was linked to minimally invasive primary procedures (92.3% versus 34.2%, p < 0.001). Bowel resection was more frequently required in late presenting cases (84.1% versus 46.2%, p = 0.009).

Conclusions: Intestinal erosion from prosthetic material is a rare complication of hernia repair leading to considerable morbidity. Prompt operative repair is key in avoiding catastrophic consequences.