Mechanical failure of a lightweight polypropylene mesh

We report the case of a 41-year-old male who underwent repair of a recurrent midline abdominal incisional hernia with components separation. The hernia defect was repaired with a 30 cm x 30 cm underlay biological (Strattice) mesh used to partially bridge a small residual gap between the rectus muscles and reinforced with a 30 cm x 30 cm lightweight polypropylene onlay mesh (BARD (TM) soft mesh). The patient later developed a large persistent seroma that was excised 18 weeks later. On exploration of the previous hernia repair, it was noted that the onlay polypropylene mesh had fractured leaving a 3 cm by 2 cm defect, but the underlying biological mesh was intact preventing a recurrence of the hernia (see Fig. 1). The fractured mesh was repaired with an additional onlay 10 cm x 10 cm polypropylene mesh, the seroma was de-roofed, and the patient was later discharged. This case highlights the early mechanical failure of a lightweight polypropylene mesh; the precise mechanism of failure in this case is unclear and, however, may be related to high intra-abdominal pressures postoperatively.