Addressing Chronic Pain After Laparoscopic Ipom Repair: A Case of Successful Tacks and Mesh Excision With Rives-Stoppa Reconstruction

Introduction Chronic pain following laparoscopic intraperitoneal onlay mesh (IPOM) repair with permanent tack fixation affects up to 13.8% of patients (Asaf Kahn et al. [2018]). In our case, this was addressed through the excision of the mesh and tacks, followed by abdominal wall reconstruction using a Rives-Stoppa repair. Case Presentation A 61-year-old woman presented with chronic abdominal pain following laparoscopic IPOM with permanent tack fixation in October 2021. Her EuraHS QoL score was 46/80 (excluding restrictions during sports), with a notable 21/30 "pain at the site of the hernia.” A CT scan revealed no evidence of hernia recurrence, 41 metallic tacks in the abdominal wall, and bilateral inguinal hernia. The surgical intervention commenced with a midline laparotomy through the previous 20 × 30 cm mesh, which was excised en-bloc with the tacks. Subsequently, a bilateral retrorectus dissection was performed, addressing both inguinal hernias. The posterior layer was progressively closed, leaving a 9 × 9 cm defect that was bridged with a 9 × 15 cm biosynthetic polyglycolic acid/trimethylene carbonate mesh. Later, a 20 × 45 cm polyvinylidene fluoride (PVDF) retromuscular mesh was placed, and the anterior layer was completely closed. The postoperative period was uneventful. At the one-month follow-up, the patient exhibited significant improvement in "pain at the site of the hernia" with a 9/30 score, still somewhat limited by postoperative pain, resulting in a EuraHS QoL score of 37/80. Conclusion Permanent tacks can contribute to chronic pain. An optimal repair requires the complete excision of the tacks and proper abdominal wall reconstruction.