Atypical Mycobacterial Infection Following Laparoscopic Inguinal Hernia Repair: Experience in Five Cases

Five cases of atypical mycobacterial infection were encountered following laparoscopic inguinal hernia repair in our surgical unit from 2012 to 2015. Few weeks after surgery the patient presented with erithematous indurated swelling on working port with discharge of pus and sinus formation .CECT of abdomen showed abscess formation at the site of mesh and sinus extending extraperitoneally up to the working port without intraperitoneal connection. Pus culture was sterile with positive PCR for mycobacterium tuberculosis. The cases were clinically diagnosed to be atypical mycobacterial infection .Before opting to remove the implanted mesh to control infection by reoperation we attempted a conservative approach to control infection..We treated with local irrigation of sinus with gentamicyn and oral antibiotic combination of clarithromicyn and prulifloxacin for few weeks. With this management the sinus healed and infection was controlled. Reuse of tacker after chemical sterilization was thought to be the reason of contamination with atypical mycobacteria in these cases which is a preventable by using ethylene oxide sterilization.