EP 239 Can the Metal Tackers Come Back and Bite?
Varun Arunagiri, Saqib AliAbstract
Introduction
Intraperitoneal onlay mesh (IPOM) repair is widely used with composite meshes and tackers to fix the mesh. Tackers can be either absorbable or non-absorbable. In the early era of laparoscopic ventral hernia repair, metal tackers were commonly used. They are less commonly used recently, with absorbable fixation methods now preferred. We report a rare and delayed complication that occurred 16 years after IPOM repair with metal tackers.
Case Report
A 74-year-old man presented with abdominal pain and clinical features of small-bowel obstruction. His medical history included atrial fibrillation, hypertension, and benign prostatic hypertrophy. Computed tomography of the abdomen and pelvis demonstrated a closed-loop small-bowel obstruction. No operative records were initially available. He had an emergency laparotomy, and a composite mesh was noted with a metal tacker. The omentum was densely adherent to the tackers, encasing the small-bowel mesentery, resulting in a closed-loop obstruction. After reviewing past records, it was noted that multiple open umbilical hernia repairs were performed in 2006 and 2007, followed by laparoscopic IPOM repair with metal tack fixation in 2008. The small bowel was resected, and a primary side-to-side anastomosis was performed. The postoperative recovery was uneventful.
Conclusion
Intraperitoneal fixation of mesh using metal tackers can lead to delayed complications. The omentum, acting as a protective organ, may rapidly adhere to foreign material; however, entrapment around the small-bowel mesentery can result in closed-loop obstruction. This case highlights a serious long-term complication of metal tack use in IPOM repair, which appears less common following preperitoneal mesh placement.