Colocutaneous fistula after mesh plug inguinal hernia repair- a delayed complication

Hernia repair is among the oldest and the most common operation in a surgeon’s technical armamentarium. Unfortunately, it is widely acknowledged that primary inguinal hernia repair will result in a 10% to 15% recurrence rate with an even higher percentagefollowing the repair of a recurrent inguinal hernia. Numerous surgical techniques to repair inguinal hernia have been described in the literature. This includes an important advancement in the reduction of tissue tension, which was the pioneering work of Usher and associates who first reported the use of Marlex (monofilament knitted polypropylene) mesh in the repair of inguinal and incisional hernias in 1958. These surgeons utilized the mesh prosthesis to buttress and reinforce a previously sutured repair. The term “tension free” hernioplasty was first used in the literature by Liechtenstein and colleagues in 1986. The authors described a surgical technique that consisted of a suture on lay mesh patch as the primary repair.1 This series consisted of 1000 consecutive patients followed for as long as 5 years without significant recurrence and with rapid return to full activities. The significance of this report is that the mesh prosthesis is not utilized to buttress or support a primary sutured herniorrhaphy but is the actual repair.1 Gilbert was the first to describe the sutureless repair of inguinal hernia.2 Rutkow presented a follow-up of 2403 patients from 1989 to 1994 for almost 6 years of tension free mesh plug herniorrhaphy with less than 1% recurrence rate of the primary and 2% recurrent herniorrhaphy.3 This procedure was associated with a minimum of postoperative complications such as urinary retention, infection involving the mesh, ischemic orchitis, vascular and embolic, long-term pain and a draining sinus tract.4 However, though several complications have been related to the tissue tension free technique, rare complications that are secondary to the mesh migration have been reported.