A 61-year-old Chinese lady presented with a 6-month history of a localised abdominal swelling and distention one and a half years post-midline laparotomy for a bleeding peptic ulcer. Her co-morbidities include a mild hiatus hernia and ischaemic heart disease for which she was on a low-molecular-weight heparin and a platelet inhibitor. She is American Society of Anaesthesiologists (ASA) Grade II and is not on regular non-steroidal, anti-inflammatory medications. On examination, an incisional hernia was found at the previous laparotomy site. It had a smooth surface and a positive cough impulse. The patient underwent a laparoscopic intraperitoneal placement onlay mesh repair for her hernia. An Optic view port (12 mm) was placed at the left subcostal region as primary port entry with two 5 mm ports at the left flank. Dense abdominal adhesions were found with small bowel adherent to the anterior abdominal wall within the hernia sac. These were localised to the hernia site. A laparoscopic adhesiolysis was done dissecting the adherent small bowel off the anterior abdominal wall. The hernia defect measured 16 cm by 20 cm. An 20.32 cm by 25.4 cm sized polypropylene mesh coated with omega 3 fatty acids (fish oil) was placed tension-free with no primary suturing and fixed with two rows of ProTack™ 5 mm titanium helical fasteners to restore the integrity of the wall. The hernia sac was not excised. A standard double crown technique with stay sutures was employed. There were no iatrogenic injuries during adhesiolysis. The patient recovered and the immediate post-operative period was uneventful. During a routine follow-up visit 3 months after the procedure, the patient complained of mild dyspepsia, intermittent abdominal pain. There was no discharge from the incision site. On examination, there was slight tenderness over the incisional hernia site but no obvious recurrence. The patient was reassured and managed conservatively. The patient’s dyspepsia and abdominal pain got progressively worse and a hard tender mass located in the epigastrium was palpated 10 months post-procedure. Computed tomography imaging of the abdomen showed thickening of the body and pylorus of the stomach and a thin soft tissue plane separating the stomach lesion and the pancreas. Gastroscopy revealed a thickened gastric antrum. There was no gross evidence of acute recurrence of her ulcer disease. Histopathological examination of biopsies taken from the gastric antrum showed chronic inflammatory granulation and fibrosis with no evidence of malignancy. The patient subsequently underwent a laparoscopy. Dense intrabdominal adhesions were found intra-operatively. There was an adhesion of the small bowel to the fish oil mesh with fine inflammatory exudates. It was converted to an open procedure. Adhesiolysis, explantation of fish oil coated mesh and ProTack™, partial gastrectomy, gastrojejunostomy and jejuno-jejunostomy were performed. There was no evidence for a recurrence of the incisional hernia. There was no evidence of fistula or chronic sepsis. A sutured repair was undertaken. The condition of the patient improved a few days after the surgery. Two samples were sent for histopathological analysis: the mesh sample and the partial gastrectomy. Macroscopic analysis of the mesh sample revealed the sample to be a torn piece of plastic mesh embedded in fibrous tissue secured by multiple metal coils. Microscopically, sections of the sample showed partly hyalinised fibrofatty tissue exhibiting an intense foreign-body granulomatous inflammatory reaction towards an amorphous translucent foreign material. The partial gastrectomy specimen had thick haemorrhagic fibrous adhesions. The mucosa showed loss of rugae and there appeared to be superficial ulcerations in the mucosa. Microscopically, the gastric specimens revealed submucosal oedema, inflammed granulation and foci of suppurative inflammatory necrosis with extension of the inflammation across the muscularis into the serosa. The patient had an unremarkable post-operative recovery and has had no further sequelae in subsequent follow-up visits.