Delayed Mesh Erosion into the Sigmoid Colon Following TEP Repair: A Case Report and Literature Review

Laparoscopic inguinal hernia repair is now standard, with totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) techniques showing similar outcomes. TEP avoids intraperitoneal manipulation, reducing the risk of organ injury, but mesh erosion is an extremely rare complication. We report the first Japanese case―and the first worldwide presenting with hematochezia―of mesh erosion into the sigmoid colon six years after TEP repair in a 67-year-old man. Colonoscopy revealed mesh protrusion, and laparoscopic-assisted sigmoidectomy with mesh removal was performed. Recovery was uneventful. Despite no intraoperative peritoneal injury, chronic inflammation, compression necrosis, and unrecognized subclinical peritoneal injury are possible mechanisms. Literature suggests a lower incidence of mesh erosion after TEP than TAPP, but vigilance is warranted. Mesh erosion should be considered in patients with lower gastrointestinal bleeding long after TEP, and early imaging is advised for unexplained gastrointestinal or urinary symptoms.