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WJOLS

Tack Sinus: A New Complication of Laparoscopic Ventral Hernia Repair

tacks has its own disadvantages. Acute problems that occur pain, mesh migration, hernia, etc. As more and more LVHRs
with nonabsorbable tacks may be related to patient are done these complications are being reported, and one
characteristics such as morbid obesity, to difficulty getting needs to be aware of these in order to tackle them rightly or
the tack to penetrate and secure the mesh adequately and better still avoid them. Newer technologies may help
various device malfunctions. 10 manufacture better configured and bioabsorbable tacks.
Tacks are known to cause pain like transfacial sutures.
Even though a permanent metal tack is not reactive in the REFERENCES
sense of causing allergy there is still inflammation around 1. McGreevy JM, Goodney PP, Birkmeyer CM, Finlayson SRG,
it and inflammation near a nerve running through a muscle Laycock WS, Birkmeyer JD. A prospective study comparing
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causes pain that can be quite disabling similar pain can be the complication rates between laparoscopic and open ventral
hernia repairs. Surg Endosc 2003;17:1778-80.
noted with absorbable tacks but its absorption will decrease 2. Sajid MS, Bokhari SA, Mallick AS, Cheek E, Baig MK.
the pain to a considerable limit. The only issue of concern, Laparoscopic versus open repair of incisional/ventral hernia: A
however, with absorbable tacks was the over all strength of meta-analysis. Am J Surg 2008;197:64-72.
attachment to abdominal wall. Recurrence of hernia 3. Morales-Conde S, Cadet H, Cano H, Bustos M, Martin J,
with only the use of tacks is higher when compared to Morales-Mendez S. Laparoscopic ventral hernia repair without
reinforcement of the mesh with transabdominal sutures. sutures—double crown technique: Our experience after
140 cases with a mean follow-up of 40 months. Int Surg 2005;
Hence, suture fixation was stronger than tacks alone. 8 90(3 Suppl):S56-62.
Two incidences of tack site hernia have been reported. 4. Wassenaar EB, Raymakers JTFJ, Rakic S. Impact of the mesh
The hernial defect was seen between the sutures rather than fixation technique on operation time in laparoscopic repair of
the site of suture evidently showing that tacks were ventral hernias. Hernia 2008;12:23-25.
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responsible for the same. Seroma formation is a common 5. Wassenaar E, Schoenmaeckers E, Raymakers J,
van der Palen J, Rakic S. Mesh-fixation method and pain and
complication after LVHR. 8 quality of life after laparoscopic ventral or incisional hernia
Migration of tacks can occur if not appropriately placed repair: A randomized trial of three fixation techniques. Surg
and they can drop into the peritoneal cavity and serve as Endosc 2010;24:1296-1302.
lead points causing small bowel obstruction at any point in 6. LeBlanc KA. Tack hernia: A new entity. JSLS 2003;7:
383-87.
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the near or distant future. The length of these helical tacks 7. Koehler RH, Voeller G. Recurrences in laparoscopic incisional
is 4 mm and width is approximately 3 mm. This penetrates hernia repairs: A personal series and review of the Literature.
approximately 3 to 4 mm into these tissues. JSLS 1999;3:293-304.
We, however, encountered a case of migration of tacks, 8. LeBlanc KA. Incisional and ventral hernia repair. Controversies
in laparoscopic surgery 30:385-96.
not a case of drop into the peritoneal cavity, but migration 9. Park A, Gagner M, Pomp A. Laparoscopic repair of large
to the anterior abdominal wall forming multiple sinus tracts. incisinal hernias. Surg Laparosc Endosc 1996;6:123-28.
This discovery of tacks migrating anteriorly toward the 10. Gillian GK, Bell R, Kroh M. Advances in absorbable fixation
abdominal wall is a completely new finding. Our patient devices for laparoscopic ventral hernia repair. General Surgery
had an obese abdomen and a thin anterior abdominal wall News 2009 June;36:05.
was not encountered to give these tacks an easy way out.
Two of these sinuses had spiral tracks along with which a ABOUT THE AUTHORS
part of the mesh was also protruding. The fact that these Bharati Vishwanath Hiremath
tacks were placed in between prolene sutures makes it
unlikely that the latter was responsible for migration of these Professor, Department of General Surgery, MS Ramaiah Medical
College, Bengaluru, Karnataka, India, e-mail: drbharti_2000@yahoo.com
tacks. Is it possible that the spiral design helps propel the
tack every time there is a sudden rise in inraperitoneal Bharathi Rajasridhar
pressure? And due to their nonabsorbable nature is it
possible that migration of these tacks may occur years later? Postgraduate Student (Final Year), Department of General Surgery
MS Ramaiah Medical College, Bengaluru, Karnataka, India

CONCLUSION Gotam Pipara
Tacks are a convenient and quick way of fixing a mesh in Postgraduate Student (First Year), Department of General Surgery
LVHR. However, their use has it’s own complications like MS Ramaiah Medical College, Bengaluru, Karnataka, India

World Journal of Laparoscopic Surgery, May-August 2012;5(2):105-107 107