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Hernia
Published in: Hernia 6/2009

01-12-2009 | Original Article

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

Authors: M. J. Tolino, D. E. Tripoloni, R. Ratto, M. I. García

Published in: Hernia | Issue 6/2009

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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.
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Metadata
Title
Infections associated with prosthetic repairs of abdominal wall hernias: pathology, management and results
Authors
M. J. Tolino
D. E. Tripoloni
R. Ratto
M. I. García
Publication date
01-12-2009
Publisher
Springer-Verlag
Published in
Hernia / Issue 6/2009
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI
https://doi.org/10.1007/s10029-009-0541-y

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