Background

The consensus of timing ventral hernia repair in bariatric surgery patients remains controversial. Outcomes on concomitant versus delayed repair are comparable. Current data suggests mesh infection after ventral hernia repair in bariatric patients is 0-1.9%. We present a 63 year old female patient with a delayed ventral mesh infection. Her initial evaluation was for a chronic abdominal wall fluid collection in the setting of a laparoscopic gastric bypass in 2008. She underwent subsequent ventral hernia repair with laparoscopic intraperitoneal onlay mesh repair. After becoming symptomatic, she underwent CT abdomen and pelvis imaging demonstrating an abdominal wall fluid collection in 2021. Eventually she underwent ultrasound guided aspiration in 2023, with recurrence of symptoms and fluid collection. Repeat imaging identified a 5 x 7 cm epigastric abdominal wall fluid collection. There was no evidence of a recurrent hernia. There was no air seen in the fluid collection and no fistula demonstrated with oral contrast. We performed diagnostic laparoscopy. On laparoscopy, we identified normal gastric bypass anatomy and a large abscess cavity in the epigastrium. Within this collection, we found a free-floating mesh, consistent with a chronic mesh infection. This was removed and a drain left in place. Post-operatively, she had resolution of her symptoms. She had no growth on fluid cultures taken in the operating room. She has no resulting hernia defect on examination. She continues to follow up annually after bariatric surgery. In conclusion, this is a post-bypass patient who developed a sterile abscess after delayed hernia repair, requiring mesh excision.