Laparoscopic transabdominal preperitoneal repair for inguinal hernia in a patient with an adult Still's disease receiving anti-interleukin-6 receptor monoclonal antibody therapy.

Abstract

Tocilizumab, a monoclonal antibody drug against interleukin-6 receptor, has been reported to cause wound infection and delayed wound healing. Therefore, surgeries using artificial materials in patients receiving tocilizumab require careful observation. A 75-year-old man who had been receiving tocilizumab and steroids for the treatment of adult Still's disease was diagnosed with an inguinal hernia and underwent laparoscopic transabdominal preperitoneal repair. Tocilizumab administration was discontinued for 3 weeks before surgery and was restarted 2 weeks after the surgery. Postoperatively, there was no fever, and the C-reactive protein level was marginally elevated. The patient was discharged from the hospital on the fourth day without any postoperative complications, and no delayed infection or delayed wound healing 1 year after the surgery. A few weeks withdrawal of tocilizumab administration before and after surgery permitted safe laparoscopic hernia surgery using a surgical mesh without infection or delayed wound healing.