CASE REPORT
A Calcified Foreign Body in the Bladder due
to a Displaced Tack: An Unusual Complication
After Laparoscopic Incisional Hernia Repair
Xavier Feliu, MD,* Ramon Claveria, MD,* Pere Besora, MD,*
Dionisio Luque, MD,w and Xavier Viñas, MD*
Abstract: We report a rare complication caused by a displaced tack
after laparoscopic incisional hernia repair. A 41-year-old woman
treated 11 months earlier for a suprapubic incisional hernia
(Pfannenstiel laparotomy) received a laparoscopic repair with a
bilaminar mesh fixed with tacks. Seven months later, she presented
miccional irritative symptoms and chronic lower abdominal pain.
Leucocyturia and microhematuria were present, and computerized
tomography showed 2 calcified nodules in the bladder wall.
Cystoscopy confirmed 2 calcified foreign bodies in the bladder
due the tack fixation. She underwent an intra-abdominal laparoscopic exploration, which showed the protrusion of a mesh in the
urinary bladder. The tacks were removed and a partial laparoscopic cystectomy including mesh protrusion was performed. The
patient was discharged from hospital 4 days later without
postoperative complications. At follow-up 24 months after surgery,
she remains well with no pain, urinary symptoms, or hernia
recurrence.
Key Words: displaced tacks, laparoscopic incisional hernia
complication, calcified foreign body in urinary bladder
(Surg Laparosc Endosc Percutan Tech 2011;21:e28–e30)
L
aparoscopic repair of incisional hernia is a minimally
invasive surgical procedure that has established itself as
a valuable alternative in incisional hernia treatment. A
meta-analysis comparing this procedure with the open
approach confirmed that laparoscopic repair is safe and
presents minimal postoperative morbidity, short hospital
stay, and a low recurrence rate.1
Spiral titanium tacks are routinely used for mesh
fixation in these procedures. Although complications related
to use of spiral tacks seem to be rare, isolated incidences have
been described (for instance, nerve entrapment and bowel
perforation) after laparoscopic repair of wall defects.2–6
Bladder calcification with subsequent stone formation
after laparoscopic repairs has been reported in a few cases
after laparoscopic inguinal herniorrhaphy. The case reported here is the first case in incisional hernia.
Received for publication November 10, 2009; accepted August 4, 2010.
From the *Department of General and Laparoscopic Surgery; and
wUrology Unit, Hospital General d’Igualada, Avda, Catalunya,
Igualada, Barcelona, Spain.
Reprints: Xavier Feliu, MD, Department of General and Laparoscopic
Surgery, Hospital General d’Igualada, Avda, Catalunya 11,
Igualada, Barcelona 08700 Spain (e-mail: [email protected]).
Copyright r 2011 by Lippincott Williams & Wilkins
e28 | www.surgical-laparoscopy.com
CASE REPORT
A 41-year-old woman treated 11 months earlier for a
suprapubic incisional hernia (Pfannenstiel laparotomy) received
laparoscopic repair with a bilaminar mesh fixed with tacks.
Eleven months later, she presented miccional irritative
symptoms and chronic lower abdominal pain. Leucocyturia and
microhematuria were present, but no evidence of infection was seen
in urine culture. Computerized tomography showed 2 calcified
nodules in the bladder wall (Fig. 1).
Cystoscopy confirmed 2 calcified foreign bodies in the bladder
due the tacks fixation (Fig. 2). The patient underwent an intraabdominal laparoscopic exploration, which showed a mesh
protrusion in the urinary bladder. The tacks were removed and a
partial laparoscopic cystectomy including mesh protrusion was
performed. It was not necessary to re-repair the hernia defect
(Fig. 3). The patient was discharged from hospital 4 days later
without postoperative complications. At follow-up 24 months after
surgery, she remains well with no pain, urinary symptoms, or
hernia recurrence.
Bladder calcification with subsequent stone formation after
laparoscopic repairs have been reported in a few cases after
herniorrhaphy. This case is the first case in incisional hernia.
DISCUSSION
Laparoscopic incisional hernia treatment has become
increasingly popular because of reports of reductions in
hospital stay, postoperative pain, risks of infection, complication rates, and recurrence reported by expert surgeons.7–9
However, there are no well-designed prospective comparative trials to show the superiority of this treatment over the
open approach.10,11
Although laparoscopic incisional hernia treatment has
enthusiastic supporters, and excellent results have been
reported in the hands of expert surgeons; the reality is that
its growth has been less spectacular than initially expected,
and in fact, many laparoscopic surgeons do not perform
this procedure in their daily practice. A recent internet
survey of surgeons in the United States reported that while
96% performed laparoscopic cholecystectomies, only 10%
performed laparoscopic incisional hernia repairs.12 Similar
results were reported in Spain in 2004 where 90% of
surgeons performed laparoscopic cholecystectomies but
only 18% of surgeons performed incisional hernia repair.13
The success of laparoscopic ventral hernia repair will
depend on appropriate patient selection. Postoperative
complications or recurrence are often the consequence of
technical errors. Adequate size and fixation of the mesh are
the most important factors.14
Common postoperative complications of laparoscopic
repair include seroma, wound infection, ileus, hematoma,
and persistent postoperative pain.7 Bladder calcification
Surg Laparosc Endosc Percutan Tech
Volume 21, Number 1, February 2011
Surg Laparosc Endosc Percutan Tech
Calcified Foreign Body
in the Bladder due to a Displaced Tack
Volume 21, Number 1, February 2011
FIGURE 1. A and B, computerized tomography showed 2 calcified nodules in the bladder wall.
FIGURE 2. Cystoscopic view of calcified foreign body in the
bladder due to tack fixation.
with subsequent stone formation after laparoscopic repairs
has occasionally been reported after laparoscopic inguinal
hernia repair, but this case is the first case in incisional
hernia.4
In our patient, as in earlier reports, the tack inserted
into the bladder wall was the nidus of the bladder stone
formation and the cause of urinary symptoms subsequently
presented by the patient.
A displaced tack is a postoperative complication that
must be taken into account, given its possible medicolegal
consequences.
Suprapubic incisional hernias are especially complex.
An adequate overlap must be found to provide the
necessary surface area for mesh-host tissue integration
and to avoid bladder damage, but this is particularly
difficult. The dissection plane is similar to the one used for
laparoscopic transabdominal preperitoneal inguinal hernia
repair with fixation in Cooper ligaments, combining the use
of transfixing transabdominal sutures with tacks.15
New alternatives in mesh fixation, such as absorbable
tacks or glues, can help to overcome these problems, but
surgeons must be thoroughly familiar with the technique.
Careful dissection of the retropubic space and adequate
size, overlap and fixation of the mesh is mandatory.
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FIGURE 3. Mesh protrusion in the urinary bladder.
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2011 Lippincott Williams & Wilkins
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