Page 28 - Journal of WALS

WJOLS

10.5005/jp-journals-10007-1159
CASE REPORT Tack Sinus: A New Complication of Laparoscopic Ventral Hernia Repair
Tack Sinus: A New Complication of Laparoscopic

Ventral Hernia Repair

Bharati Vishwanath Hiremath, Bharathi Rajasridhar, Gotam Pipara

ABSTRACT reported so far in literature, i.e. migration of tacks through
the anterior abdominal wall forming multiple sinuses which
In this era of laparoscopic surgery, laparoscopic repair of ventral
hernia is gaining popularity due to faster recovery, shorter henceforth may be referred to as ‘tack sinus’.
hospital stay and lower recurrence rates. In obese patients it is
a technically easier procedure than open repair. However, this CASE REPORT
new method requires advanced technologies. Transfacial
sutures and tacks are the usual methods to fix the mesh to the A 50-year-old diabetic lady, underwent elective
anterior abdominal wall. These methods, however, have their laparoscopic paraumbilical mesh hernia repair on 25.06.10
own complications. This article is to report an unusual
complication of tacks migrating and trying to extrude out of under general anesthesia. Two ports were used. One
anterior abdominal wall, forming chronic sinuses. 10 mm port at Palmar’s point and a 5 mm port placed
Keywords: Laparoscopy, Tack, Sinus. laterally in the left flank. All adhesions were released.
Dual mesh was introduced through the 10 mm port. This
How to cite this article: Hiremath BV, Rajasridhar B, Pipara G. mesh was sized to lie 3 cm beyond the size of the defect. It
Tack Sinus: A New Complication of Laparoscopic Ventral Hernia
Repair. World J Lap Surg 2012;5(2):105-107. was fixed with prolene transfacial sutures at all the four
corners and in the center at the site of the defect. The fixation
Source of support: Nil
was further enforced by using tacks (nonabsorbabale
Conflict of interest: None declared helical titanium) at the periphery and around the defect
(DC method). Total number of 15 tacks were used.
INTRODUCTION Postoperative recovery of the patient was uneventful and
Laparoscopic ventral hernia repair (LVHR) has gained patient was discharged on 2nd day postoperative. Port site
popularity over the recent years ever since introduced by sutures were removed on 8th day.
Karl Leblanc in 1992. It has a number of advantages over She presented 8 weeks later with two discharing sinuses
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traditional open hernia repair. It continues to gain on the anterior abdominal wall in the infraumbilical region.
popularity because of its low rates of complications and The serous discharge and scrapings from these sinuses was
hernia recurrence and short hospital stay and short recovery thoroughly investigated by culture sensitivity of the
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times. There are various methods of mesh fixation. discharge for routine and tuberculous culture and sensitivity.
Currently, two methods of mesh fixation are commonly acid-fast bacillus (AFB) staining of the discharge showed
employed. One involves placement of both transabdominal no tuberculous bacilli. There was no growth seen in either
sutures (TAS), either absorbable or nonabsorbable, and of the cultures. Patient was treated with regular curettage
tacks; the other entails insertion of two circles of tacks and dressings. Patient was, however, lost to follow-up.
without TAS [the double-crown (DC) technique]. 3 This patient presented to us again in the month of
Numerous studies have proven that transfacial sutures are October 2011. At this visit she had four discharging sinuses
a must for fixing the mesh in terms of strength while the in the infraumbilical region. This time too the discharge
tacks provide extra reinforcement. However, fixing with was serous in nature. Induration was felt at the site of the
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transfacial sutures takes a longer time and is a more tedious discharging sinuses. A soft tissue scan of the anterior
process. Tacks are used in laparoscopic ventral hernia repair abdominal wall showed these sinus tracts extending up to
to decrease the operative time and the number of the fascia only. The lower two of these sinuses were multi-
subcutaneous prolene knots of the transfacial sutures are truncated. An exploration and excision of these sinuses was
used. Moreover, the ease of their application makes their planned.
use even more appealing. Intraoperatively, it was seen that these sinuses were
However, usage of tacks has its own disadvantages and formed of very thick fibrous tissue. To our surprise two of
complications. Besides being expensive, various these sinus tracks had the spiral tacks in them above the
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complications have been reported like tack site pain, tack level of fascia. These tacks had dragged the mesh along
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hernia, recurrence of hernia and seroma formation. This with them. A few millimeter length of the mesh was
is a case report of a new complication that has not been protruding in each of these two sinuses. However, the mesh
World Journal of Laparoscopic Surgery, May-August 2012;5(2):105-107 105