ModeratorAugust 22, 2015 at 6:42 am
Laparoscopically placed mesh can be removed off the transversus abdominis. Some muscle will be injured as part of the removal, as the muscle has grown into the mesh. Surgeon technique and surgical technique can help reduce the injury. It is usually not a major problem. There is minimal muscle tissue that is removed with the mesh and it typically does not affect abdominal wall strength.
I recommend that laparoscopically-placed mesh be removed laparoscopically. To do so via an open laparotomy, in my opinion, is causing too much extra damage and instability to the abdominal wall, cutting through the abdomen full thickness to get to the mesh. The recovery is also much longer. That said, there are not that many surgeons who routinely perform mesh removal laparoscopically. Mesh removal itself has risks of vessel (external iliac artery/vein), bladder, spermatic cord, and nerve (genitofemoral or lateral femorocutaneous) injury regardless of technique.
I have switched to performing all of these with robotic assistance, and have found the results to be much better, with less injury.