Small bowel obstruction owing to displaced spiral tack after laparoscopic TAPP inguinal hernia repair.

Fitzgerald, Heidi L; Orenstein, Sean B; Novitsky, Yuri W

Laparoscopic repair of inguinal hernias has become a widely accepted technique owing to its safety, efficacy, and patient satisfaction. Laparoscopic inguinal herniorrhaphies, such as the transabdominal preperitoneal (TAPP) and the totally extraperitoneal approaches, usually employ a method of fixation involving staples, titanium spiral tacks, or sutures to secure the mesh over the myopectineal orifice. The TAPP approach also requires closure of the peritoneal flap to exclude the mesh from the intraabdominal contents. Overall complication rates with TAPP are low, with small bowel obstruction incidence of 0.2% to 0.5%. This is usually attributed to inadequate peritoneal closure, trocar site herniation, or adhesions. We report a case of small bowel obstruction caused by a displaced spiral tack used for the peritoneal closure during TAPP hernia repair.