Comparison of Complete Versus Partial Mesh Removal for the Treatment of Chronic Mesh Infection After Abdominal Wall Hernia Repair

Hernia. 2018 Oct;22(5):773-779. doi: 10.1007/s10029-018-1785-1. Epub 2018 May 23.

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.

Keywords: Complete removal; Incisional hernia; Mesh infection; Partial removal.

Publication types

  • Comparative Study

MeSH terms

  • Abdominal Wall / surgery
  • Adult
  • Aged
  • Device Removal / methods*
  • Female
  • Hernia, Abdominal / surgery*
  • Humans
  • Male
  • Middle Aged
  • Surgical Mesh / adverse effects*
  • Surgical Wound Infection / surgery*
  • Young Adult