Management of infected mesh post laparoscopic transabdominal pre-peritoneal inguinal hernia repair.

A 49-year-old man presented to the emergency department with a six-week history of fevers, weight loss and feeling unwell with anorexia. He had a history of a laparoscopic transabdominal pre-peritoneal left inguinal hernia repair seven weeks prior. An abdominal computer tomography scan showed a collection surrounding the mesh. Initial management involved oral antibiotics and ultrasound-guided drainage. Unfortunately, his symptoms and the collection persisted, and he required surgical intervention. After laparoscopy confirmed the containment of the infection to the pre-peritoneal space, the collection was approached via a moderate skin incision above the inguinal canal. This approach allowed for drainage of the collection, removal of the mesh and a thorough washout and drain placement without disturbing future hernia repair options nor exposing the intra-abdominal compartment to infection. The patient recovered well and was discharged five days after the operation. He did require another brief period of intravenous antibiotics before being discharged once more.