Internal herniation as a complication of tension-free vaginal tape implantation: A report of two cases

Tension-free vaginal tape (TVT) is often placed for stress urinary incontinence. A number of gastrointestinal complications following TVT placement have been previously described. Internal herniation through this pelvic mesh, however, has not yet been documented. Herein, we describe the presenting symptoms and operative management strategies of this rare complication. Two patients who presented to our institution were ultimately found to have internal herniation through TVT mesh and managed differently. Both patients presented complaining of unilateral sharp flank pain and were initially worked up for renal colic; computed tomography of the kidney, ureters, and bladder raised suspicion for small bowel obstruction. Both were taken to the theater. In one case, exploratory laparotomy revealed necrotic strangulated small bowel herniating through a defect in the TVT mesh. We performed small bowel resection and mesh explantation with postoperative return of urinary incontinence. In the other case, the hernia was reduced laparoscopically revealing noninfracted small bowel. The mesh defect was obliterated with interrupted sutures. Flank pain and symptoms of bowel obstruction with a history of TVT placement should prompt surgeons to consider internal herniation. The extent of ischemia and the need for small bowel resection are factors that should be considered when deciding whether to manage open or laparoscopically and whether to preserve or remove the mesh.