Osteitis pubis after laparoscopic totally extraperitoneal inguinal hernia repair: An uncommon complication – Report of two cases

Osteitis pubis is a well-known complication of urologic and gynecologic procedures but its association with hernioplasty is poorly documented in the literature. We are reporting two cases of osteitis pubis following laparoscopic hernia repair. In first case, a 52-year-old man underwent bilateral totally extra-peritoneal repair (TEP) for bilateral inguinal hernia. Mesh fixation was done with metallic (titanium) tackers at iliopubic tract. Two weeks later he complained of sharp stabbing pain in the pubic area and dull aching pain on inner aspect of right thigh more during abduction and extension of hip joint. There was no associated fever or local signs of acute inflammation. Roentgenogram and MRI showed changes typical of osteitis pubis. There was no evidence of infection in the urinary tract or elsewhere. The patient was managed conservatively with analgesics and physiotherapy. Patient recovered well. In second case, a 40-years-old male underwent bilateral totally extra-peritoneal repair (TEP) for bilateral inguinal hernia with mesh fixation with metallic tackers at iliopubic tract. After 20 days of surgery patient developed pain on medial aspect of thigh which was exaggerated on extension and abduction at hip joint. Again, Roentgenogram and MRI showed changes typical of osteitis pubis. This patient was also managed conservatively on same line as previous case.