Based on extensive evaluation by gynecology and general surgery, the patient consented to undergo laparoscopy for diagnoses of endometriosis and mesh-related chronic pain reaction. Laparoscopy demonstrated severe endometriosis, and she underwent extensive adhesiolysis and painstaking endometriosis excision, which involved her rectum, uterus, adnexa, and pelvic side walls. The mesh was confirmed to be flat and in appropriate position. No attempt was made at mesh removal.

Her postoperative recovery was difficult; she required a lot of assistance from the pain management specialists to develop a combination therapy of opioids, neuromodulating medications, muscle relaxants, and antidepressants to help control her pain. She was also maintained on hormonal therapy for her endometriosis.

Upon follow-up, much of her chronic symptoms remained. She continued to have chronic pelvic pain, fatigue, lower abdominal bloating, pain with full bladder, swelling and tingling of the upper thighs, feeling of “hotness,” and weakness of the extremities. She was losing her hair. She could not maintain her weight. She remained in bed most of the day and could not function to perform her normal daily activities. She had weaned herself off of most of her medications, as they were ineffective in addressing her symptoms or she developed intolerances to them, such as nausea, vomiting, and dizziness. Evaluation by gynecology and further imaging demonstrated no suggestion of recurrence of her endometriosis.

Due to the direct relationship between the hernia repair with mesh and her debilitated state at such a young age, she was offered laparoscopic mesh removal. She understood that this might not cure her of her problem and that indeed there was no concrete diagnosis. Also, she understood the risks of the procedure, which included the risk of nerve injury and vessel injury at the time of mesh removal. She underwent uneventful laparoscopic mesh removal bilaterally. No hernias were noted after mesh removal.

In anticipation of a difficult postoperative course, she had an epidural placed preoperatively. This allowed for smooth recovery postoperatively. She had shown sensitivity to many different pain medications and was able to tolerate pain control with ice and acetaminophen. Pathology of the mesh demonstrated dense fibrosis and chronic inflammation with foreign body giant cell reaction . Over a span of 1 year, she was able to recuperate toward a more normal life. Repeat MRI confirmed no hernia recurrence. She is now eating and gaining weight. Her hair loss has stopped. She is regaining her conditioning with physical therapy.