A case report: Can a Titanised polypropylene mesh (TiMesh) obviate a dual mesh for sandwich technique for parastomal hernias??

Abstract

The three main surgical techniques for PSH are primary fascial repair, stoma reconstruction, and mesh reconstruction. Both open & laparoscopic repair can be done for PSH and currently mesh reinforcement is widely accepted. Polypropylene mesh permeates the ingrowth of adjacent fascia and potentially adhering onto adjacent organs, including the viscera, leading to mesh erosion and enteric fistula. Polytetrafluoroethylene (PTFE) mesh shrinks significantly in the tissue and thereby increases the chances of PSH recurrence rate. TiMesh (Healthium Medtech, Bengaluru, India) is a titanium-coated polypropylene composite mesh and is included in the guidelines for laparoscopic treatment of ventral & incisional abdominal wall hernias by International Endo hernia Society (IEHS). TiMesh can be used to repair PSH and maybe a useful alternative to dual mesh. We present a case report of a 64-year-old lady who presented with a parastomal hernia after an abdomino-perineal resection and an end sigmoid colostomy. The parastomal hernia was repaired using a laparoscopic meshplasty using TiMesh. With a Dual mesh, the polypropylene side may come in contact with the bowel with a possibility of mesh erosion and fistulation. TiMesh being a coated mesh on both sides reduces these possibilities.