Skip to main content

Advertisement

Log in

Infections associated with prosthetic repairs of abdominal wall hernias: pathology, management and results

  • Original Article
  • Published:
Hernia Aims and scope Submit manuscript

Abstract

Purpose

To analyse clinical and demographic factors of patients who suffered infection of the surgical site requiring mesh removal as a complication of prosthetic repairs, details of the hernioplasties in which meshes were implanted and their management and outcomes.

Methods

Factors related to infection (demographic variables and characteristics of the repairs and mesh utilised) and the management before proceeding to mesh removal were obtained from patient charts. Collected specimens (meshes and tissues) from 32 consecutive patients were cultured and observed microscopically. The outcomes after mesh removal were prospectively evaluated.

Results

Twenty-two patients underwent incisional hernioplasties and ten inguinal hernioplasties; most of the procedures took a long time, and 28 patients presented early wound complications (seroma or haematoma). During the “implantation–removal” interval, some conservative treatments, such as drainages or sinus resection, were attempted under local anaesthesia. Twenty-two meshes were totally removed (nine after partial extraction); in the remaining ten cases partially removal was successful. Most of the meshes (24) were made of multifilament polypropylene; microscopic observation of neighbouring tissues showed leucocyte infiltration, giant cell reaction, disorganisation of the collagen fibres and abscedation. Treatment of 32 patients required 51 operations. Following mesh removal, there were six recurrences and two fistulas of the bowel. The average follow-up was 40 months (30–97).

Conclusions

Most of the infections requiring mesh removal were related to prolonged repair operations that presented untreated early postoperative wound complications. Partial extraction of meshes frequently leads to failures and complications. Surgical exploration should be performed under general anaesthesia to accomplish complete mesh extraction.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Burger J, Luijendijk RW, Hop W, Halm J, Verdaasdunk E, Jeekel J (2004) Long-term follow-up of a randomised control trial of suture versus mesh-repair of incisional hernia. Ann Surg 240:578–585

    PubMed  Google Scholar 

  2. Luijendijk RW, Hop W, Van Del Tol M et al (2000) A comparison of suture-repair with mesh-repair for incisional hernia. NEJM 343:392–398

    Article  CAS  PubMed  Google Scholar 

  3. Falagas M, Kasiakou S (2005) Mesh-related infections after hernia repair surgery. Clin Microbiol Infect 11:3–8

    Article  CAS  PubMed  Google Scholar 

  4. Schachtrupp A, Klinge U, Junge K et al (2002) Individual inflammatory response of human blood monocytes to mesh biomaterials. Br J Surg 90:114–120

    Article  Google Scholar 

  5. Gilbert A, Felton L (1993) Infection in inguinal hernia repair considering biomaterials and antibiotics. Surg Ginecol Obst 177:126–130

    CAS  Google Scholar 

  6. Grant A (2002) Open mesh versus non-mesh repair of groin hernia: meta-analysis of randomised trials based on individual patient data. Hernia 6:130–136

    Article  CAS  PubMed  Google Scholar 

  7. Shulman A, Amid P, Lichtenstein I (1992) The safety of mesh repair for primary inguinal hernia: results of 3,019 operations from five diverse sources. Am Surg 58:255–257

    CAS  PubMed  Google Scholar 

  8. Basoglu M, Yildirgan I, Balik A et al (2004) Late complications of incisional hernias following prosthetic mesh repair. Acta Chir Belg 104:425–428

    CAS  PubMed  Google Scholar 

  9. Klinge U, Klosterhalfen B, Birkenhauer V, Junge K, Conze J, Schumpelick V (2002) Impact of polymer pore size on the interface scar formation in a rat model. J Sur Res 103:208–214

    Article  CAS  Google Scholar 

  10. Klosterhalfen B, Junge K, Hermanns B, Klinge U (2002) Influence of implantation interval on the long-term biocompatibility of surgical mesh. Br J Surg 89:1043–1048

    Article  CAS  PubMed  Google Scholar 

  11. Papadimitriou J, Petros P (2005) Histological studies of monofilament and multifilament propylene mesh implants demonstrate equivalent penetration of macrophages between filaments. Hernia 9:75–78

    Article  PubMed  Google Scholar 

  12. Avtan L, Avci C, Bulut T, Fourtanier G (1997) Mesh infections after laparoscopic inguinal hernia repair. Surg Laparosc Endosc 7:192–195

    Article  CAS  PubMed  Google Scholar 

  13. Bauer J, Harris M, Kreel I (1999) Twelve-year experience with expanded polytetrafluoroethylene in the repair of abdominal wall defects. Gelernt I Mt Sin J Med 66:20–25

    CAS  Google Scholar 

  14. Cobb W, Harris J, Lokey J, McGill E, Klove K (2003) Incisional herniorrhaphy with intraperitoneal composite mesh: a report of 95 cases. Am Surg 69:784–787

    PubMed  Google Scholar 

  15. Heniford B, Park A, Ramshaw B, Voeller G (2003) Laparoscopic repair of ventral hernias: nine years’ experience with 850 consecutive hernias. Ann Surg 238:391–400

    PubMed  Google Scholar 

  16. Fawole A, Chaparala R, Ambrose N (2006) Fate of the inguinal hernia following removal of infected prosthetic mesh. Hernia 10:58–61

    Article  CAS  PubMed  Google Scholar 

  17. Moon V, Chaudry G, Choy C, Ferzli G (2004) Mesh infection in the era of laparoscopy. J Laparoendosc Adv Surg Tech 14:349–352

    Google Scholar 

  18. Petersen S, Henke G, Freitag M et al (2001) Deep prosthesis infection in incisional hernia repair: predictive factors and clinical outcome. Eur J Surg 167:453–457

    Article  CAS  PubMed  Google Scholar 

  19. Taylor E, Duffy K, Lee K et al (2004) Surgical site infection after groin hernia repair. Br J Surg 91:105–111

    Article  CAS  PubMed  Google Scholar 

  20. Department of Health, Human Services, Centers for Disease Control, Prevention, Guidelines for prevention of surgical site infection (1999) Hospital Infection Control Practices Advisory Committee. Am J Inf Control 27:250–278

    Google Scholar 

  21. Amid P (1997) Classification of biomaterials and their related complications in abdominal wall hernia surgery. Hernia 1:15–21

    Article  Google Scholar 

  22. Amid P (2004) Radiologic images of meshoma. Arch Surg 139:1297–1298

    Article  PubMed  Google Scholar 

  23. Arnaud J, Eloy R, Adloff M, Grenier J (1977) Critical evaluation of prosthetic materials in repair of abdominal wall hernias. Am J Surg 133:338–345

    Article  CAS  PubMed  Google Scholar 

  24. Yerdel M, Akin E, Dolalan S, Turkcapar A, Pehlivan M, Gecim I, Kuterdem E (2001) Effect of single-dose prophylactic ampicillin and sulbactam on wound infection after tension-free inguinal hernia repair with polypropylene mesh: the randomised, double-blind, prospective trial. Ann Surg 233:26–33

    Article  CAS  PubMed  Google Scholar 

  25. Gilbert AI, Graham MF (1997) Infected grafts of incisional hernioplasties. Hernia 1:77–81

    Article  Google Scholar 

  26. Taylor G, O′Dwyer P (1999) Chronic groin sepsis following tension-free inguinal hernioplasty. Br J Surg 86:562–565

    Article  CAS  PubMed  Google Scholar 

  27. Deysine M (2004) Post mesh herniorraphy infection control: are we doing all we can? Hernia 8:90–91

    Article  PubMed  Google Scholar 

  28. Perez A, Roxas M, Hilvano S (2005) A randomized, double-blind, placebo-controlled trial to determine effectiveness of antibiotic prophilaxis for tension-free mesh herniorraphy. J Am Coll Surg 200:393–397

    Article  PubMed  Google Scholar 

  29. Ríos A, Rodriguez J, Munitiz V et al (2001) Antibiotic prophylaxis in incisional hernia repair using a prosthesis. Hernia 5:148–152

    Article  PubMed  Google Scholar 

  30. Mann D, Prout J, Havranek E et al (1998) Late-onset deep prosthetic infection following mesh repair on inguinal hernia. Am J Surg 76:12–14

    Article  Google Scholar 

  31. Darouiche R (2004) Treatment of infections associated with surgical implants. NEJM 350:1422–1429

    Article  CAS  PubMed  Google Scholar 

  32. Bellón J, García-Carranza A, García-Honduvilla N et al (2004) Tissue integration and biomechanical behaviour of contaminated experimental polypropylene and expanded polytetrafluoroethylene implants. Br J Surg 91:489–494

    Article  PubMed  Google Scholar 

  33. Greca F, Paula J, Biodo-Simoes et al (2001) The influence of differing pore sizes on the biocompatibility of two polipropylene meshes in the repair of abdominal defect. Experimental study in dogs. Hernia 5:59–64

  34. Junge K, Rosch R, Klinge U et al (2005) Gentamicin supplementation of polyvinyldenfluoride mesh materials for infection prophilaxis. Biomaterials 26:787–793

    Article  CAS  PubMed  Google Scholar 

  35. Conze J, Rosch R, Klinge U, Weiss C et al (2004) Polipropilene in the intraabdominal position: influence of pore size and surface area. Hernia 8:365–372

    Article  CAS  PubMed  Google Scholar 

  36. Klinge U, Junge K, Spellerberg B, Piroth C, Klosterhalfen B, Schumpelick V (2002) Do multifilament alloplastic meshes increase the infection rate? Analysis of the polymeric surface, the bacteria adherence, and the in vivo consequences in a rat model. J Biomed Mater Res 63:765–771

    Article  CAS  PubMed  Google Scholar 

  37. Welty G, Klinge U, Klosterhalfen B (2001) Functional impairment and complaints following incisional hernia repair with different polypropylene meshes. Hernia 5:142–147

    Article  CAS  PubMed  Google Scholar 

  38. Costerton J, Stewart P, Greemberg E (1999) Bacterial biofilms: a common cause of persistent infections. Science 284:1318–1322

    Article  CAS  PubMed  Google Scholar 

  39. Darouiche R (2003) Antimicrobial approaches for preventing infections associated with surgical implants. Clin Infect Dis 36:1284–1289

    Article  PubMed  Google Scholar 

Download references

Conflict of interest statement

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to M. J. Tolino.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tolino, M.J., Tripoloni, D.E., Ratto, R. et al. Infections associated with prosthetic repairs of abdominal wall hernias: pathology, management and results. Hernia 13, 631–637 (2009). https://doi.org/10.1007/s10029-009-0541-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10029-009-0541-y

Keywords

Navigation