Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Hernia
Published in: Hernia 5/2018

01-10-2018 | Original Article

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

Authors: S. Levy, D. Moszkowicz, T. Poghosyan, A. Beauchet, M. -M. Chandeze, K. Vychnevskaia, F. Peschaud, J. -L. Bouillot

Published in: Hernia | Issue 5/2018

Login to get access

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.
Literature
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):392–398CrossRefPubMed
2.
Kokotovic D, Bisgaard T, Helgstrand F (2016) Long-term recurrence and complications associated with elective incisional hernia repair. JAMA 316(15):1575CrossRefPubMed
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):648–657CrossRefPubMed
4.
Cobb WS, Carbonell AM, Kalbaugh CL et al (2009) Infection risk of open placement of intraperitoneal composite mesh. Am Surg 75(9):762–768PubMed
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):545–549CrossRefPubMed
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):1035–1037CrossRefPubMedPubMedCentral
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):249–252CrossRef
8.
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):287CrossRefPubMedPubMedCentral
10.
Delikoukos S, Tzovaras G, Liakou P et al (2007) Late-onset deep mesh infection after inguinal hernia repair. Hernia 11(1):15–17CrossRefPubMed
11.
Fawole AS, Chaparala RP, Ambrose NS (2005) Fate of the inguinal hernia following removal of infected prosthetic mesh. Hernia 10(1):58–61CrossRefPubMed
12.
Johanet H, Contival N (2011) Mesh infection after inguinal hernia mesh repair. J Visc Surg 148(5):e392–e394CrossRefPubMed
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) CrossRefPubMed
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):231–237CrossRefPubMed
15.
Sabbagh C, Verhaeghe P, Brehant O et al (2012) Partial removal of infected parietal meshes is a safe procedure. Hernia 16(4):445–449CrossRefPubMed
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):544–558CrossRefPubMed
17.
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):50–57CrossRefPubMed
19.
Chung L, Tse GH, O’Dwyer PJ (2014) Outcome of patients with chronic mesh infection following abdominal wall hernia repair. Hernia 18(5):701–704CrossRefPubMed
20.
Taylor SG, O’Dwyer PJ (1999) Chronic groin sepsis following tension-free inguinal hernioplasty. Br J Surg 86:562–565CrossRefPubMed
21.
Fawole AS, Chaparala RP, Ambrose NS (2006) Fate of the inguinal hernia following removal of infected prosthetic mesh. Hernia 10(1):58–61CrossRefPubMed
22.
Leber GE, Garb JL, Alexander AI et al (1998) Long-term complications associated with prosthetic repair of incisional hernias. Arch Surg 133(4):378–382CrossRefPubMed
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):453–457CrossRefPubMed
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):1702–1709CrossRefPubMed
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):67–73CrossRefPubMed
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):145–153PubMed
27.
Shankaran V, Weber DJ, Reed RL II (2011) A review of available prosthetics for ventral hernia repair. Ann Surg 253(1):16–26CrossRefPubMed
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 14:131CrossRefPubMedPubMedCentral
29.
Conze J, Krones CJ, Schumpelick V et al (2007) Incisional hernia: challenge of re-operations after mesh repair. Langenbecks Arch Surg 392:453–457CrossRefPubMed
30.
Welty G et al (2001) Functional impairment and complaints following incisional hernia repair with different polypropylene meshes. Hernia 5:142–147CrossRefPubMed
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 31:234–244CrossRefPubMed
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 10:247–253PubMed
33.
den Hartog D, Dur AH, Tuinebreijer WE et al (2008) Open surgical procedures for incisional hernias. Cochrane Database Syst Rev 3:CD006438
34.
Szczerba SR, Dumanian GA (2003) Definitive surgical treatment of infected or exposed ventral hernia mesh. Ann Surg 237(3):437–441PubMedPubMedCentral
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):287–291CrossRefPubMedPubMedCentral
Metadata
Title
Comparison of complete versus partial mesh removal for the treatment of chronic mesh infection after abdominal wall hernia repair
Authors
S. Levy
D. Moszkowicz
T. Poghosyan
A. Beauchet
M. -M. Chandeze
K. Vychnevskaia
F. Peschaud
J. -L. Bouillot
Publication date
01-10-2018
Publisher
Springer Paris
Published in
Hernia / Issue 5/2018
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI
https://doi.org/10.1007/s10029-018-1785-1

Other articles of this Issue 5/2018

Hernia 5/2018 Go to the issue

Correction

Correction to: Electric cauterization of the hernia sac in laparoscopic ventral hernia repair reduces the incidence of postoperative seroma: a propensity score-matched analysis

Original Article

Associations between anxiolytic medications and ventral hernia repair

Original Article

Paravertebral blocks reduce the risk of postoperative urinary retention in inguinal hernia repair

Original Article

The impact of hospital volume on clinical and economic outcomes in ventral hernia repair: an analysis with national policy implications

Original Article

Safety and effectiveness of umbilical hernia repair in patients with cirrhosis

Original Article

A call for standardization of wound events reporting following ventral hernia repair