Chronic Abdominal Pain following the TAPP Hernioplasty, Caused by Appendix Attached to the Polypropylene Mesh Rakic Mislav * , Klicek Robert, Amic Fedor, Matej Andabak and Patrlj Leonardo Department of Hepatobiliary Surgery, University Hospital Dubrava, Zagreb, Croatia * Corresponding author: Rakic Mislav, Department of Hepatobiliary Surgery, University Hospital Dubrava, Zagreb, Croatia, Tel: 0038598 891-925, E-mail: mislav78@gmail.com Received date: September 5, 2018; Accepted date: September 17, 2018; Published date: September 25, 2018 Copyright: © 2018 Mislav R, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract We report a case of 42 y old male patient with chronic pain in the lower right abdominal quadrant that appeared almost every time after or during exercise, for a last two years. The patient underwent transabdominal preperitoneal patch hernioplasty (TAPP), due to the right inguinal hernia two and a half years ago. There were no comorbidities or other previous operations in his medical records. Since the abdominal ultrasound (US) and magnetic resonant (MR) with laboratory methods did not show any special findings, the laparoscopy was performed and the appendix was found with apex attached to the polypropylene mesh, preperitoneal positioned at the place of the previous hernioplasty. The appendix was divided carefully and the laparoscopic appendectomy was performed. There were no complications during the operation or postoperative period. The pathohistological exam showed chronic inflammatory mononuclear infiltration at the sampled appendix. During the follow-up period of two years, the patient experienced no abdominal pain nor any other symptoms and/or complications. In the current literature, we did not find this kind of complication following the TAPP procedure. This case is a unique presentation of chronic abdominal pain following the TAPP procedure caused with the position of the attached appendix. Keywords: Transabdominal preperitoneal patch hernioplasty (TAPP); Chronic abdominal pain; Laparoscopic appendectomy Introduction Inguinal hernia repair is among the most common surgical procedures performed worldwide [1], with the estimated annual incidence of inguinal hernia repair being 130-160 operations per 100,000 inhabitants [2]. Te laparoscopic inguinal hernia repair presents a promising therapeutic pathway nowadays especially in bilateral and recurrent hernias [3]. Te same as any other surgical procedure it could be accompanied by several complications. Tey are usually grouped as the following: a) complications associated with laparoscopy; b) the ones related to the patient; c) those related to hernioplasty itself [4]. In the 17.1% of the hernioplasty operations are usually accompanied with minor complications such as transient groin pain, seroma, transient leg pain or testicular and spermatic cord problems and hematoma [5]. Te impaired bowel passage was reported early afer the operation that was managed conservatively, but also the adhesive ileus that required reoperation and the adhesiolysis six months following the operation [6,7]. According to literature, there are only a few cases in which the laparoscopic hernia repair was brought in the connection with the development of acute appendicitis [7]. On the other hand, some other reports present another interesting issue in the setting of an inguinal hernia and appendicitis, which is De Garrengeot hernia where the appendix is included in hernia sac, the synchronous laparoscopic appendectomy and TAPP hernioplasty can be performed safely in these cases [8,9]. However, numerous studies with long-term follow-up have shown that the rate of chronic postoperative pain is high and that it is one of the major complications afecting patients that undergo laparoscopic hernia repairs [10,11]. However, there were no any reports and/or studies presenting the TAPP hernioplasty as a possible trigger for chronic abdominal pain caused by attachment of the appendix to the preperitoneal positioned prosthetic material. Terefore we present an unusual case of a young male patient presented with chronical pain in the right lower abdominal quadrant, three years following the TAPP hernioplasty, where the appendix was found attached to the preperitoneal positioned polypropylene mesh. Case Report We report a case of 42 y old male patient with chronic pain in the lower right abdominal quadrant that lasted for more than two years, and it was related to exercise. Tis pain started to show afer TAPP hernioplasty which patient underwent due to the right inguinal hernia 3 years ago. Tere were no other comorbidities in his medical records. Since the imaging (abdominal US and MR) and laboratory methods did not show any special fndings, the laparoscopy was performed and the apex of the appendix was found attached to the polypropylene mesh which was positioned preperitoneal. So the appendix was long- drawn in the right down part of the abdominal cavity (Figure 1). Laparoscopic appendectomy was performed. Tere were no complications during the early or late postoperative period. Te pathohistological exam has shown chronic infammatory mononuclear infltration at the sampled appendix. During the two years of follow up, no abdominal pain or any other complications were not reported by the patient. J o u r n a l o f M e d i c a l & S u r g i c a l P a t h o l o g y ISSN: 2472-4971 Journal of Medical & Surgical Pathology Mislav et al., J Med Surg Pathol 2018, 3:4 DOI: 10.4172/2472-4971.1000165 Case Report Open Access J Med Surg Pathol, an open access journal ISSN:2472-4971 Volume 3 • Issue 4 • 1000165