PAIN PLUG EXPLANT USING TAPP TECHNIQUE

Abstract Introduction Chronic pain in patients after inguinal hernia repair can be a serious problem that affects patients' lives. It is therefore important to prevent, as far as possible, the situations that can cause it, one of which is excess mesh and its placement in an inappropriate area. Case We present a very thin male patient who underwent surgery for a right inguinal hernia using a mesh plug technique three months post-operatively and began to experience persistent groin pain that worsened with exertion and left him incapacitated throughout the day. This pain was not consistent with a dermatoma. Examination revealed induration in the area, with no clinical recurrence. The patient was referred for surgery due to pain and the previous mesh explant. A laparoscopic approach was performed with a transabdominal laparoscopic approach (TAPP), where no recurrence was observed but a folded mesh plug was found. Explant and repair with flat mesh without traumatic fixation were performed. The patient reported an improvement in pain, although it did not disappear completely. No recurrence at follow-up 12 months. Discussion The use of mesh plugs has been questioned on many occasions, not only because of problems related to chronic postoperative pain but also because of the migration of the plug into the cavity. The excessive folding of the mesh favours the formation of meshomas which are difficult to explant due to their proximity to blood vessels and nerve structures, which can be injured by compression or irritation.