Zusammenfassung
GRUNDLAGEN: An sich senkt der laparoskopische Zugang das Risiko früher postoperativer Infektionen, die in 0,3–0,5% der Fälle auftreten können. Wir berichten den ersten Fall einer Spätinfektion in Form eines Bauchwandabszesses nach laparoskopischer Hernien-Operation mit Netzimplantation. METHODIK: Fallbericht über einen 30-jährigen Mann 3 Jahre nach laparoskopischer Hernien-Operation. Es fand sich ein Abszess (15,73 × 12,29 cm) vom Rektus zur Psoas-Muskulatur reichend (CT-Befund). ERGEBNISSE: Mittels eines perkutan gestochenen Katheters (Boston Scientific® Sump drainage catheter 12F) wurden 2700 ml aus der Eiterung entfernt, Acinetobacter lwoffii kultiviert und entsprechend mit Ciprofloxacin, Ceftazidime und Piperacilin + Tazobactam behandelt. Nach 77 Tagen wurde der Katheter entfernt. Der Patient ist seit 3,5 Jahren beschwerdefrei. SCHLUSSFOLGERUNGEN: Auch nach einer laparoskopischen Hernien-Operation kann als Spätkomplikation ein Abszess auftreten.
Summary
BACKGROUND: The laparoscopic approach reduces the risk of early postoperative infection which ranges from 0.3% to 0.5%. We report the first case of late abscess formation of a mesh after laparoscopic hernia repair. METHODS: A 30-year-old man who had had a laparoscopic hernia repair by total extraperitoneal approach 3 years ago. Physical examination was normal except hardness in all lower abdominal quadrant. In laboratory study, WBC: 13.2/mm3 (n: 4–10/mm3). [Cystic mass harmonized with abscess was found 15.73 × 12.29 cm in size in front of rectus near to psoas muscle at the back at abdominal and pelvic CT.] RESULTS: Percutaneous catheter (Boston Scientific® Sump drainage catheter 12F) was settled under local anesthesia. Approximately 2700 cc purulent drainage occured. Acinetobacter lwoffii had grown in purulent material's culture. Patient responded to ciprofloxacin, ceftazidime and piperacilin + tazobactam and therefore antibiotic therapy had been given. Seventy-seven days later, drainage was stopped from catheter and catheter had been removed. Patient has no complaint for 3.5 years. CONCLUSIONS: TEP is a safe and easy operation; however, it may be responsible for late abscess occurring.
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Ozlem, N. Enormous abscess growth at abdominal wall three years after laparoscopic herniorrhaphy. Eur Surg 41, 51–54 (2009). https://doi.org/10.1007/s10353-009-0444-2
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DOI: https://doi.org/10.1007/s10353-009-0444-2