Late-Onset Ileocutaneous Fistula Eight Years After Plug Repair With Polypropylene Mesh: A Case Report

Introduction: As one of the short-term complications after inguinal hernia repair, mesh infection frequently occurs but rarely leads to ileocutaneous fistula. We present a rare case of ileocutaneous fistula 8 years after inguinal hernia plug repair with polypropylene mesh.Case Presentation: The patient was a 67-year-old male who underwent a plug repair with polypropylene mesh of the right inguinal hernia. Eight years after the primary repair, skin ulceration with pus presented in the right groin area, and the final diagnosis was enterocutaneous fistula. According to laparoscopic exploration, the ileum below the fistula closely adhered to the abdominal wall. After gently separating the bowel loop, a defect area of about 2 × 3 cm was observed on the surface of the ileum. In laparotomy, the plug was found embedded in the ileum and then was completely removed, and an ileum side-to-side anastomosis was performed. The patient was discharged 2 weeks after the surgery, and follow-up at the sixth month revealed complete healing of the wound and no evidence of hernia recurrence.Conclusion: Late-onset ileocutaneous fistula should be considered in the differential diagnosis in patients who present inflammation and abscess formation after hernia repair. Besides, for patients with suspected intestinal fistula after hernia repair, laparoscopic exploration should be given priority, and the mesh removal approach should be tailored according to the results of laparoscopic exploration.

One inch incision-mesh plug repair versus laparoscopic trans-abdominal preperitoneal repair of the primary indirect inguinal hernia: a prospective comparative study

Background: Management of inguinal hernia by minimally invasive incision and minimal dissection with optimal outcomes remains an unmet need for general surgeons. The most common hernia repair procedures are Lichtenstein hernioplasty and laparoscopic hernia repair; TAPP and TEP. The modification of mesh plug repair (MPR); one inch incision-MPR (OI-MPR); could achieve optimal outcomes comparable to that of laparoscopic hernia repair. The objective of the study was to assess OI-MPR approach for management of primary indirect inguinal hernia and its outcomes in comparison to laparoscopic TAPP repair.Methods: During the period from September 2017 to March 2019, 63 patients with indirect inguinal hernia were selected randomly to one of two groups; group-A included 35 patients underwent one inch incision-mesh plug repair (OI-MPR), group-B included 28 patients underwent laparoscopic TAPP.Results: The mean operative time of group-A was 31.74±4.74 min which was significantly shorter than that of group-B (81.22±7.44 min). The mean hospital stay duration in group-A was 0.57±0.18 day and in group-B, it was 1.18±0.39 day. The patients of group-A returned to normal physical activities earlier than the patients of group-B. The duration of postoperative pain was shorter and less severe in group-A than that of group-B. Regarding complications, there was no statistically significant difference found between both groups.Conclusions: One inch incision-MPR is a simple, feasible and cost-effective approach with low morbidities and low burden on the patients and the healthcare facilities.

The Effect of Plug Rotation Speed on Micro-Structure of Nugget Zone of Friction Plug Repair Welding Joint for 6082 Aluminum Alloy

This paper carried out the friction plug repair welding of 6082 aluminum alloy keyhole defects by using the method of friction heating between shaft shoulder and base material. In addition, a well-formed friction plug welding joint was obtained at different plug rotation speeds. In order to study the influence mechanism of plug rotation speeds on the microstructure of the weld nugget zone, EBSD technology was used to analyze the grain morphology, grain size and grain boundary characteristics of the weld nugget zone under different rotation speeds of the plug rod. The results show that in the nugget zone, the grain was fine and equated crystals refinement, and there was a preferred orientation. The deformation texture components in the welded nugget zone increased with the plug rotation speed from 1600 to 2000 rpm. However, the grain size first decreased and then increased, while the components in the High-Angle Boundary first increased and then decreased.

Management of an obstructed recurrent inguinal hernia using a hybrid method: a case report

Background For recurrent incarcerated and strangulated hernias, the optimal treatment strategy for each case is needed. Case presentation The study patient was a 70-year-old man. TAPP repair was performed for a left inguinal hernia (JHS Classification II-1) 7 years earlier. The patient experienced transient pain and swelling of the left inguinal region for 5 months and visited our emergency department for abdominal pain and vomiting. A CT scan showed a recurrent left inguinal hernia and small bowel incarceration, and emergency surgery was performed. Laparoscopic observation of the abdominal cavity revealed recurrent left inguinal hernia (Rec II-1) with small bowel incarceration. The small bowel was reduced after pneumoperitoneum, and no findings suggested intestinal tract necrosis. Adhesions around the herniated sac were dissected using an extraperitoneal approach and then shifted to mesh plug repair. No perioperative complications or hernia recurrence were observed in the 10 months after the surgery. Conclusions This report describes a novel, successful surgical treatment for a recurrent incarcerated hernia. In our patient, we could easily perform dissection and understand the positional relationship by hybrid surgery using the TEP method. Additionally, in patients with incarcerated hernias, we believe that performing hybrid surgery by combining the TEP method would be useful because bowel dilation caused by intestinal obstruction would not disturb the operative field.

Friction plug repair welding of glass fiber-reinforced polyamide 6: Investigation of morphology, microstructure, and mechanical properties

Friction plug repair welding technology has been demonstrated to be effective to repair the glass fiber-reinforced polyamide 6 sheets in the present paper. Influences of repair hole geometries and parameters on joint morphology and mechanical performance were investigated. Results showed that defect-free repaired joints were produced with the utilization of tapered holes rather than cylindrical holes. Process parameters exerted significant influences on the cross-sectional profile and morphology of the joints. Defect-free repaired welds with larger stir zone thicknesses were produced with the proper increase of rotational speeds, but excessive rotational speeds caused the formation of cavities along the plug boundary and the reduction of stir zone thicknesses. The fluctuation of the wavy bottom interface increased under larger plunge rates and incomplete connections between stir zone and base material were observed under plunge rate of 25 mm/min. Extended dwell time led to larger stir zone thickness and improved joint morphology. Tensile tests showed that the strength of the repaired joints increased and then decreased with the enlargement of rotational speeds. Decreased plunge rate and extended dwell time led to promoted joint mechanical performance. Three failure modes were observed, which corresponded to low, middle, and high repaired weld strengths.

Mesh Plug Technique for Umbilical and Paraumbilical Hernias Repair; A Novel Technique

Background: Umbilical and paraumbilical herniae are the most common ventral herniae occurring at or around the umbilical ring.Umbilical hernia accounts for almost 6-10% of all abdominal wall herniae. A ventral hernia is abnormal protrusion of peritoneal sacthrough the musculo-aponeurotic abdominal wall defect. Females are affected five times more as compared to males. The variousrisk factors include obesity, chronic cough and constipation, ascites and pregnancy in females.Objective: To determine the outcome of mesh plug repair of umbilical and paraumbilical hernias in terms of operative time andpostoperative complications.st Material and Methods: This study was conducted at surgical department of Khyber Teaching Hospital, Peshawar from 1 Januaryst 2012 to 31 December 2016. Total of 131 patients with umbilical and Para umbilical hernias were studied. Patients were operatedusing mesh plug technique and operative time and postoperative complications were recorded.Results: There were 91 female patients compared to 40 male patients (M/F ratio 2.2:1). The overall mean age was 41±19.3 years.The mean operative time was 23±9.2minutes. In the early postoperative period 3 patients had superficial surgical site infection.Seroma was observed in 2 patients. Mesh plug infection was observed in 1 patient while chronic pain was observed in 2 patients.None of the patients had recurrence on 24 months follow up.Conclusion: Mesh plug for small umbilical and paraumbilical hernias in adults is a safe, convenient, fast and minimally invasivetechnique with a lower rate of postoperative complications and recurrence.