Skip to main content

Advertisement

Log in

Comparison of complete versus partial mesh removal for the treatment of chronic mesh infection after abdominal wall hernia repair

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

Abstract

Purpose

Treatment of chronic mesh infections (CMI) after parietal repair is difficult and not standardized. Our objective was to present the results of a standardized surgical treatment including maximal infected mesh removal.

Methods

Patients who were referred to our center for chronic mesh infection were analyzed according to CMI risk factors, initial hernia prosthetic cure, CMI characteristics and treatments they received to achieve a cure.

Results

Thirty-four patients (mean age 54 ± 13 years; range 23–72), were included. Initial prosthetic cure consisted of 26 incisional hernias and eight groin or umbilical hernias of which 21% were considered potentially contaminated because of three intestinal injuries, two stomas and two strangulated hernias. The mesh was synthetic in all cases. CMI appeared after a mean of 83 days (range 30–6740) and was characterized by chronic leaking in 52 cases (50%), an abscess in 22 cases (21%) and synchronous hernia recurrence in 17 cases (16.5%). Eighty-six reinterventions were necessary, including 36 mesh removals (42%), and 13 intestinal resections for entero-cutaneous fistula (15%). The CMI persistence rate was 81% (35 reinterventions out of 43) when mesh removal was voluntarily limited to infected and/or not incorporated material, but was 44% when mesh removal was voluntarily complete (19 reinterventions out of 43; p < 0.001). On average, 3.4 interventions (1–11) were necessary to achieve a cure, after 2.8 years (0–6). Fourteen incisional hernia recurrences occurred (41%).

Conclusions

Treatment of chronic mesh infection is lengthy and resource-intensive, with a high risk of hernia recurrence. Maximal mesh removal is mandatory.

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

Similar content being viewed by others

References

  1. Luijendijk RW, Hop WC, van den Tol MP, de Lange DC et al (2000) A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med 343(6):392–398

    Article  CAS  PubMed  Google Scholar 

  2. Kokotovic D, Bisgaard T, Helgstrand F (2016) Long-term recurrence and complications associated with elective incisional hernia repair. JAMA 316(15):1575

    Article  PubMed  Google Scholar 

  3. Hawn MT, Snyder CW, Graham LA et al (2010) Long-term follow-up of technical outcomes for incisional hernia repair. J Am Coll Surg 210(5):648–657

    Article  PubMed  Google Scholar 

  4. Cobb WS, Carbonell AM, Kalbaugh CL et al (2009) Infection risk of open placement of intraperitoneal composite mesh. Am Surg 75(9):762–768

    PubMed  Google Scholar 

  5. Trunzo JA, Ponsky JL, Jin J et al (2009) A novel approach for salvaging infected prosthetic mesh after ventral hernia repair. Hernia 13(5):545–549

    Article  CAS  PubMed  Google Scholar 

  6. Alston D, Parnell S, Hoonjan B et al (2013) Conservative management of an infected laparoscopic hernia mesh: a case study. Int J Surg Case Rep 4(11):1035–1037

    Article  PubMed  PubMed Central  Google Scholar 

  7. Aguilar B, Chapital AB, Madura II et al (2010) Conservative management of mesh-site infection in hernia repair. J Laparoendosc Adv Surg Tech 20(3):249–252

    Article  Google Scholar 

  8. Chung L, Tse GH, O’Dwyer PJ (2014) Outcome of patients with chronic mesh infection following abdominal wall hernia repair. Hernia 18(5):701–704. https://doi.org/10.1007/s10029-014-1277-x

    Article  CAS  PubMed  Google Scholar 

  9. Akyol C, Kocaay F, Orozakunov E et al (2013) Outcome of the patients with chronic mesh infection following open inguinal hernia repair. J Korean Surg Soc 84(5):287

    Article  PubMed  PubMed Central  Google Scholar 

  10. Delikoukos S, Tzovaras G, Liakou P et al (2007) Late-onset deep mesh infection after inguinal hernia repair. Hernia 11(1):15–17

    Article  CAS  PubMed  Google Scholar 

  11. Fawole AS, Chaparala RP, Ambrose NS (2005) Fate of the inguinal hernia following removal of infected prosthetic mesh. Hernia 10(1):58–61

    Article  PubMed  Google Scholar 

  12. Johanet H, Contival N (2011) Mesh infection after inguinal hernia mesh repair. J Visc Surg 148(5):e392–e394

    Article  CAS  PubMed  Google Scholar 

  13. Bueno-Lledó J, Torregrosa-Gallud A, Carreño-Saénz O et al (2016) Partial versus complete removal of the infected mesh after abdominal wall hernia repair. Am J Surg 214:47–52 (pii: S0002-9610(16)30957-6)

    Article  PubMed  Google Scholar 

  14. Meagher H, Clarke Moloney M, Grace PA (2015) Conservative management of mesh-site infection in hernia repair surgery: a case series. Hernia 19(2):231–237

    Article  CAS  PubMed  Google Scholar 

  15. Sabbagh C, Verhaeghe P, Brehant O et al (2012) Partial removal of infected parietal meshes is a safe procedure. Hernia 16(4):445–449

    Article  CAS  PubMed  Google Scholar 

  16. Breuing K, Butler CE, Ferzoco S et al (2010) Incisional ventral hernias: review of the literature and recommendations regarding the grading and technique of repair. Surgery 148(3):544–558

    Article  PubMed  Google Scholar 

  17. Boullenois H, Moszkowicz D, Poghosyan T et al (2016) Surgical management of chronic mesh infection following incisional hernia repair. J Visc Surg 153(6):461–464. https://doi.org/10.1016/j.jviscsurg.2016.09.007. (Epub 15 Nov 2016)

    Article  CAS  PubMed  Google Scholar 

  18. Bueno-Lledó J, Torregrosa-Gallud A, Sala-Hernandez A et al (2017) Predictors of mesh infection and explantation after abdominal wall hernia repair. Am J Surg 213(1):50–57

    Article  PubMed  Google Scholar 

  19. Chung L, Tse GH, O’Dwyer PJ (2014) Outcome of patients with chronic mesh infection following abdominal wall hernia repair. Hernia 18(5):701–704

    Article  CAS  PubMed  Google Scholar 

  20. Taylor SG, O’Dwyer PJ (1999) Chronic groin sepsis following tension-free inguinal hernioplasty. Br J Surg 86:562–565

    Article  CAS  PubMed  Google Scholar 

  21. Fawole AS, Chaparala RP, Ambrose NS (2006) Fate of the inguinal hernia following removal of infected prosthetic mesh. Hernia 10(1):58–61

    Article  CAS  PubMed  Google Scholar 

  22. Leber GE, Garb JL, Alexander AI et al (1998) Long-term complications associated with prosthetic repair of incisional hernias. Arch Surg 133(4):378–382

    Article  CAS  PubMed  Google Scholar 

  23. 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(6):453–457

    Article  CAS  PubMed  Google Scholar 

  24. Stremitzer S, Bachleitner-Hofmann T, Gradl B et al (2010) Mesh graft infection following abdominal hernia repair: risk factor evaluation and strategies of mesh graft preservation. A retrospective analysis of 476 operations. World J Surg 34(7):1702–1709

    Article  PubMed  Google Scholar 

  25. Berrevoet F, Vanlander A, Sainz-Barriga M et al (2013) Infected large pore meshes may be salvaged by topical negative pressure therapy. Hernia 17(1):67–73

    Article  CAS  PubMed  Google Scholar 

  26. Shubinets V, Carney MJ, Colen DL et al (2018) Management of infected mesh after abdominal hernia repair: systematic review and single-institution experience. Ann Plast Surg 80(2):145–153

    CAS  PubMed  Google Scholar 

  27. Shankaran V, Weber DJ, Reed RL II (2011) A review of available prosthetics for ventral hernia repair. Ann Surg 253(1):16–26

    Article  PubMed  Google Scholar 

  28. Mariette C, Briez N, Denies F et al (2013) Use of biological mesh versus standard wound care in infected incisional ventral hernias, the SIMBIOSE study: a study protocol for a randomized multicenter controlled trial. Trials 14:131

    Article  PubMed  PubMed Central  Google Scholar 

  29. Conze J, Krones CJ, Schumpelick V et al (2007) Incisional hernia: challenge of re-operations after mesh repair. Langenbecks Arch Surg 392:453–457

    Article  PubMed  Google Scholar 

  30. Welty G et al (2001) Functional impairment and complaints following incisional hernia repair with different polypropylene meshes. Hernia 5:142–147

    Article  CAS  PubMed  Google Scholar 

  31. Weyhe D et al (2007) Improving outcomes in hernia repair by the use of light meshes—a comparison of different implant constructions based on a critical appraisal of the literature. World J Surg 31:234–244

    Article  PubMed  Google Scholar 

  32. Schmidbauer S et al (2005) Heavy-weight versus low-weight polypropylene meshes for open sublay mesh repair of incisional hernia. Eur J Med Res 10:247–253

    CAS  PubMed  Google Scholar 

  33. den Hartog D, Dur AH, Tuinebreijer WE et al (2008) Open surgical procedures for incisional hernias. Cochrane Database Syst Rev 3:CD006438

    Google Scholar 

  34. Szczerba SR, Dumanian GA (2003) Definitive surgical treatment of infected or exposed ventral hernia mesh. Ann Surg 237(3):437–441

    PubMed  PubMed Central  Google Scholar 

  35. Akyol C, Kocaay F, Orozakunov E et al (2013) Outcome of the patients with chronic mesh infection following open inguinal hernia repair. J Korean Surg Soc 84(5):287–291

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

No financial disclosures to make.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to D. Moszkowicz.

Ethics declarations

Conflict of interest

SL, DM, AB, MMC, TP, KV, FP, and JLB declare no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Research involving human and/or animal participants

I hereby undersign and certificate that this article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent obtained from every patient prior to inclusion.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Levy, S., Moszkowicz, D., Poghosyan, T. et al. Comparison of complete versus partial mesh removal for the treatment of chronic mesh infection after abdominal wall hernia repair. Hernia 22, 773–779 (2018). https://doi.org/10.1007/s10029-018-1785-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10029-018-1785-1

Keywords

Navigation