Delayed Enterocutaneous Fistula Following Incisional Hernia Repair Using the Plug-and-Patch Technique: A Report of a Surgically Managed Case.

Abstract

<h4>Introduction</h4>For inguinal hernia repair, the plug-and-patch technique is commonly employed. Although abdominal wall hernias are occasionally treated with plugs, their safety remains uncertain. Herein, we report a surgical case of enterocutaneous fistula occurring 18 years after incisional hernia repair using the plug-and-patch technique.<h4>Case presentation</h4>An 89-year-old woman presented with right lower abdominal discomfort and a skin ulcer and was admitted to our hospital. She had undergone an open appendectomy 64 years prior, followed by incisional hernia incarceration (leading to small intestinal resection) and suture hernia repair 20 years prior. The incisional hernia recurred 2 years postoperatively and was repaired using a mesh. Physical examination revealed a skin ulcer with purulent discharge and erythema on the right lower abdomen surrounding the surgical wound. Contrast-enhanced CT revealed an enterocutaneous fistula. Fasting, drainage, and antibiotic therapy were required before surgery. Laparoscopic resection of the intestinal loop involving the enterocutaneous fistula and the entire mesh was performed. The fascia was closed without a mesh. No hernia recurrence was observed after 39 months.<h4>Conclusions</h4>The use of plugs is simple but might not be suitable for incisional hernia repair.