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Published in: Hernia 2/2015

01-04-2015 | Original Article

Conservative management of mesh-site infection in hernia repair surgery: a case series

Authors: H. Meagher, M. Clarke Moloney, P. A. Grace

Published in: Hernia | Issue 2/2015

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Abstract

Purpose

The aim of this study is to assess the outcome of conservative management of infected mesh grafts following abdominal wall hernia repair.

Methods

This study retrospectively examined the charts of patients who developed mesh-site infection following surgery for abdominal hernia repair to determine how effective conservative management in the form of antibiotics and wound management was on the resolution of infection and wound healing.

Results

Over a period of 30 months, 13 patients developed infected mesh grafts post-hernia repair surgery. Twelve patients were successfully treated conservatively with local wound care and antibiotics if clinically indicated. One patient returned to theatre to have the infected mesh removed. Of the patients that healed eleven were treated with negative pressure wound therapy (VAC®).

Conclusion

This series of case studies indicate that conservative management of abdominal wall-infected hernia mesh cases is likely to be successful.
Literature
1.
go back to reference National Institute for Clinical Excellence (2008) Surgical site infection prevention and treatment of surgical site infection. NICE Clinical Guidelines, No. 74, National Collaborating Centre for Women’s and Children’s Health (UK). RCOG Press, London National Institute for Clinical Excellence (2008) Surgical site infection prevention and treatment of surgical site infection. NICE Clinical Guidelines, No. 74, National Collaborating Centre for Women’s and Children’s Health (UK). RCOG Press, London
2.
go back to reference Smyth ET, McIlvenny G, Enstone JE et al (2008) Four country healthcare associated infection prevalence survey 2006; overview of the results. J Hosp Infect 69:230–248CrossRefPubMed Smyth ET, McIlvenny G, Enstone JE et al (2008) Four country healthcare associated infection prevalence survey 2006; overview of the results. J Hosp Infect 69:230–248CrossRefPubMed
3.
go back to reference Horan TC, Gaynes RP, Martone WJ et al (1992) CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 13:606–608CrossRefPubMed Horan TC, Gaynes RP, Martone WJ et al (1992) CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 13:606–608CrossRefPubMed
4.
go back to reference Kingsworth A, LeBlanc K (2003) Hernias: inguinal and incisional. Lancet 362:1561–1571CrossRef Kingsworth A, LeBlanc K (2003) Hernias: inguinal and incisional. Lancet 362:1561–1571CrossRef
5.
go back to reference Saettele TM, Bachman SL, Costello CR, Grant SA, Cleveland DS, Loy TS, Kolder DG, Ramshaw BJ (2007) Use of porcine dermal collagen as a prosthetic mesh in a contaminated field for ventral hernia repair: a case report. Hernia 11(3):279–285CrossRefPubMed Saettele TM, Bachman SL, Costello CR, Grant SA, Cleveland DS, Loy TS, Kolder DG, Ramshaw BJ (2007) Use of porcine dermal collagen as a prosthetic mesh in a contaminated field for ventral hernia repair: a case report. Hernia 11(3):279–285CrossRefPubMed
6.
go back to reference Kissane NA, Itani KM (2012) A decade of ventral incisional hernia repairs with biologic acellular dermal matrix: what have we learned? Plast Reconstr Surg 130(5 Suppl 2):194S–202SCrossRefPubMed Kissane NA, Itani KM (2012) A decade of ventral incisional hernia repairs with biologic acellular dermal matrix: what have we learned? Plast Reconstr Surg 130(5 Suppl 2):194S–202SCrossRefPubMed
7.
go back to reference Cavallaro A, Lo Menzo E, Di Vita M, Zanghì A, Cavallaro V, Veroux PF, Cappellani A (2010) Use of biological meshes for abdominal wall reconstruction in highly contaminated fields. World J Gastroenterol 16(15):1928–1933CrossRefPubMedCentralPubMed Cavallaro A, Lo Menzo E, Di Vita M, Zanghì A, Cavallaro V, Veroux PF, Cappellani A (2010) Use of biological meshes for abdominal wall reconstruction in highly contaminated fields. World J Gastroenterol 16(15):1928–1933CrossRefPubMedCentralPubMed
9.
go back to reference MacFadyen BV, Mathis CR (1994) Inguinal herniorrhaphy: complications and recurrence. Semin Laparosc Surg 1:128PubMed MacFadyen BV, Mathis CR (1994) Inguinal herniorrhaphy: complications and recurrence. Semin Laparosc Surg 1:128PubMed
10.
go back to reference Dabbas N, Adams K, Pearson K, Royle GT (2011) Frequency of abdominal wall hernias: is classical teaching out of date? J R Soc Med Short Rep 2:5CrossRef Dabbas N, Adams K, Pearson K, Royle GT (2011) Frequency of abdominal wall hernias: is classical teaching out of date? J R Soc Med Short Rep 2:5CrossRef
11.
go back to reference Hesselink VJ, Luijendijk RW, de Wilt JH, Heide R, Jeekel J (1993) An evaluation of risk factors in incisional hernia recurrence. Surg Gynecol Obstet 176:228–234PubMed Hesselink VJ, Luijendijk RW, de Wilt JH, Heide R, Jeekel J (1993) An evaluation of risk factors in incisional hernia recurrence. Surg Gynecol Obstet 176:228–234PubMed
12.
go back to reference Luijendijk RW, Hop WC, van den Tol MP et al (2000) A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med 343:392–398CrossRefPubMed Luijendijk RW, Hop WC, van den Tol MP et al (2000) A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med 343:392–398CrossRefPubMed
13.
go back to reference Schumpelick V, Conze J, Klinge U (1996) Preperitoneal meshplasty in incisional hernia repair. A comparative retrospective study of 272 operated incisional hernias. Der Chirurg 67:1028–1035 Schumpelick V, Conze J, Klinge U (1996) Preperitoneal meshplasty in incisional hernia repair. A comparative retrospective study of 272 operated incisional hernias. Der Chirurg 67:1028–1035
14.
go back to reference Petersen S, Henke G, Freitag M et al (2001) Deep prosthesis infection in incisional hernia repair: predictive factors and clinical outcome. Eur J Surg 167:453–457CrossRefPubMed Petersen S, Henke G, Freitag M et al (2001) Deep prosthesis infection in incisional hernia repair: predictive factors and clinical outcome. Eur J Surg 167:453–457CrossRefPubMed
15.
go back to reference Jezupovs A, Mihelsons M (2006) The analysis of infection after polypropylene mesh repair of abdominal wall hernia. World J Surg 30:2270–2278CrossRefPubMed Jezupovs A, Mihelsons M (2006) The analysis of infection after polypropylene mesh repair of abdominal wall hernia. World J Surg 30:2270–2278CrossRefPubMed
16.
go back to reference Mavros MN, Athansiou S, Alexiou VG, Mitsikostas PK, Peppas G, Falagas ME (2011) Risk factors for mesh-related infections after hernia repair surgery: a meta-analysis of cohort studies. World J Surg 35(11):2389–2398CrossRefPubMed Mavros MN, Athansiou S, Alexiou VG, Mitsikostas PK, Peppas G, Falagas ME (2011) Risk factors for mesh-related infections after hernia repair surgery: a meta-analysis of cohort studies. World J Surg 35(11):2389–2398CrossRefPubMed
17.
go back to reference Vrijland WW, van den Tol MP, Luijendijk RW et al (2002) Randomized clinical trial of non-mesh versus mesh repair of primary inguinal hernia. Br J Surg 89:293–297CrossRefPubMed Vrijland WW, van den Tol MP, Luijendijk RW et al (2002) Randomized clinical trial of non-mesh versus mesh repair of primary inguinal hernia. Br J Surg 89:293–297CrossRefPubMed
18.
go back to reference Kercher KW, Sing RF, Matthews BD, Heniford BT (2002) Successful salvage of infected PTFE mesh after ventral hernia repair. Ostomy Wound Manage 48:40–45PubMed Kercher KW, Sing RF, Matthews BD, Heniford BT (2002) Successful salvage of infected PTFE mesh after ventral hernia repair. Ostomy Wound Manage 48:40–45PubMed
19.
go back to reference Falagas ME, Kasiakou SK (2005) Mesh-related infections after hernia repair surgery. Clin Microbiol Infect 11:3–8CrossRefPubMed Falagas ME, Kasiakou SK (2005) Mesh-related infections after hernia repair surgery. Clin Microbiol Infect 11:3–8CrossRefPubMed
20.
go back to reference Bliziotis IA, Kasiakou SK, Kapaskelis AM, Falagas ME (2006) Mesh related infection after hernia repair: case report of an emergencing type of foreign body related infection. Infection 34:46–48CrossRefPubMed Bliziotis IA, Kasiakou SK, Kapaskelis AM, Falagas ME (2006) Mesh related infection after hernia repair: case report of an emergencing type of foreign body related infection. Infection 34:46–48CrossRefPubMed
21.
go back to reference Trunzo JA, Ponsky JL, Jin J et al (2009) A novel approach for salvaging infected prosthetic mesh after ventral hernia repair. Hernia 13:545–549CrossRefPubMed Trunzo JA, Ponsky JL, Jin J et al (2009) A novel approach for salvaging infected prosthetic mesh after ventral hernia repair. Hernia 13:545–549CrossRefPubMed
22.
go back to reference Delikoukos S, Tzovaras G, Liakou P et al (2007) Late onset deep mesh infection after inguinal hernia repair. Hernia 11:15–17CrossRefPubMed Delikoukos S, Tzovaras G, Liakou P et al (2007) Late onset deep mesh infection after inguinal hernia repair. Hernia 11:15–17CrossRefPubMed
23.
go back to reference Stremitzer S, Bachleitner-Hofmann T, Gradl B, Gruenbeck M, Bachleitner-Hofmann B, Mittlboeck M, Bergmann M (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 Stremitzer S, Bachleitner-Hofmann T, Gradl B, Gruenbeck M, Bachleitner-Hofmann B, Mittlboeck M, Bergmann M (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
24.
go back to reference Aufenacker TJ, Koelemay MJ, Gouma DJ, Simons MP (2006) Systematic review and meta-analysis of the effectiveness of antibiotic prophylaxis in prevention of wound infection after mesh repair of abdominal wall hernia. Br J Surg 93(1):5–10CrossRefPubMed Aufenacker TJ, Koelemay MJ, Gouma DJ, Simons MP (2006) Systematic review and meta-analysis of the effectiveness of antibiotic prophylaxis in prevention of wound infection after mesh repair of abdominal wall hernia. Br J Surg 93(1):5–10CrossRefPubMed
25.
go back to reference Szczerba S, Dumanian GA (2003) Definitive surgical treatment of infected or exposed ventral hernia mesh. Ann Surg 237(3):437–441PubMedCentralPubMed Szczerba S, Dumanian GA (2003) Definitive surgical treatment of infected or exposed ventral hernia mesh. Ann Surg 237(3):437–441PubMedCentralPubMed
26.
go back to reference Sajjad A, Mufti TS, Zafar A, Akbar I (2007) Conservative management of mesh site infection in ventral hernia repair. J Ayub Med Coll Abbottabad 19(4):75–77 Sajjad A, Mufti TS, Zafar A, Akbar I (2007) Conservative management of mesh site infection in ventral hernia repair. J Ayub Med Coll Abbottabad 19(4):75–77
27.
go back to reference Malone DL, Genuit T, Tracy JK et al (2002) Surgical site infections: reanalysis of risk factors. J Surg Res 103:89–95CrossRefPubMed Malone DL, Genuit T, Tracy JK et al (2002) Surgical site infections: reanalysis of risk factors. J Surg Res 103:89–95CrossRefPubMed
28.
go back to reference Demiter S, Gecim IE, Aydinuraz K et al (2001) Affinity of Staphylococcus epidermidis to various prosthetic graft materials. J Surg Res 99:70–74CrossRef Demiter S, Gecim IE, Aydinuraz K et al (2001) Affinity of Staphylococcus epidermidis to various prosthetic graft materials. J Surg Res 99:70–74CrossRef
29.
go back to reference Cobb WS, Harris JB, Lokey JS, Mc Gill ES et al (2003) Incisional herniorrhaphy with intraperitoneal composite mesh: a report of 95 cases. Am Surg 69:784–787PubMed Cobb WS, Harris JB, Lokey JS, Mc Gill ES et al (2003) Incisional herniorrhaphy with intraperitoneal composite mesh: a report of 95 cases. Am Surg 69:784–787PubMed
30.
go back to reference Arroyo A, Garcia P, Perez F et al (2001) Randomized clinical trial comparing suture and mesh repair of umbilical hernia repair in adults. Br J Surg 88:1321–1323CrossRefPubMed Arroyo A, Garcia P, Perez F et al (2001) Randomized clinical trial comparing suture and mesh repair of umbilical hernia repair in adults. Br J Surg 88:1321–1323CrossRefPubMed
31.
go back to reference Adrales G (2010) Biological meshes—indications and shortcomings. Challenging hernias post-graduate course. 12th World Congress of Endoscopic Surgery Adrales G (2010) Biological meshes—indications and shortcomings. Challenging hernias post-graduate course. 12th World Congress of Endoscopic Surgery
32.
go back to reference Ventral Hernia Working Group, Breuing K, Butler CE, Ferzoco S et al (2010) Incisional ventral hernias: review of the literature and recommendations regarding the grading and techniques of repair. Surgery 148:544–558 Ventral Hernia Working Group, Breuing K, Butler CE, Ferzoco S et al (2010) Incisional ventral hernias: review of the literature and recommendations regarding the grading and techniques of repair. Surgery 148:544–558
33.
go back to reference Bellows CF, Smith A, Malsbury J, Helton WS (2013) Repair of incisional hernias with biological prosthesis: a systematic review of current evidence. Am J Surg 205(1):85–101CrossRefPubMed Bellows CF, Smith A, Malsbury J, Helton WS (2013) Repair of incisional hernias with biological prosthesis: a systematic review of current evidence. Am J Surg 205(1):85–101CrossRefPubMed
34.
go back to reference Slater NJ, van der Kolk M, Hendriks T, van Goor H, Bleichrodt RP (2013) Biologic grafts for ventral hernia repair: a systematic review. Am J Surg 205(2):220–230CrossRefPubMed Slater NJ, van der Kolk M, Hendriks T, van Goor H, Bleichrodt RP (2013) Biologic grafts for ventral hernia repair: a systematic review. Am J Surg 205(2):220–230CrossRefPubMed
35.
go back to reference Stawicki SP, Schwarz NS, Schrag SP, Lukaszczyk JJ, Schadt ME et al (2007) Application of vacuum assisted therapy in postoperative ascetic fluid leaks: an integral part of multimodality wound management in cirrhotic patients. J Burns Wounds 6:e7PubMedCentralPubMed Stawicki SP, Schwarz NS, Schrag SP, Lukaszczyk JJ, Schadt ME et al (2007) Application of vacuum assisted therapy in postoperative ascetic fluid leaks: an integral part of multimodality wound management in cirrhotic patients. J Burns Wounds 6:e7PubMedCentralPubMed
36.
go back to reference Venturi ML, Attinger CE, Mesbahi AN et al (2005) Mechanisms and clinical applications of the vacuum assisted closure device: a review. Am J Clin Dermatol 6:185–194CrossRef Venturi ML, Attinger CE, Mesbahi AN et al (2005) Mechanisms and clinical applications of the vacuum assisted closure device: a review. Am J Clin Dermatol 6:185–194CrossRef
37.
go back to reference Chen SZ, Li J, Li XY, Xu LS (2005) Effects of vacuum assisted closure on wound microcirculation: an experimental study. Asian J Surg 28:211–216CrossRefPubMed Chen SZ, Li J, Li XY, Xu LS (2005) Effects of vacuum assisted closure on wound microcirculation: an experimental study. Asian J Surg 28:211–216CrossRefPubMed
38.
go back to reference Weed T, Ratcliffe C, Drake DB (2004) Quantifying bacterial bioburden during negative pressure wound therapy: does the wound VAC enhance bacterial clearance? Ann Plast Surg 52:279–280CrossRef Weed T, Ratcliffe C, Drake DB (2004) Quantifying bacterial bioburden during negative pressure wound therapy: does the wound VAC enhance bacterial clearance? Ann Plast Surg 52:279–280CrossRef
39.
go back to reference DeFranzo AJ, Pitzer K, Molnar JA, Marks MW, Change MC, Miller PR, Letton RW, Argenta LC (2008) Vacuum-assisted closure for defects of the abdominal wall. Plastic Reconstr Surg 121(3):832–839CrossRef DeFranzo AJ, Pitzer K, Molnar JA, Marks MW, Change MC, Miller PR, Letton RW, Argenta LC (2008) Vacuum-assisted closure for defects of the abdominal wall. Plastic Reconstr Surg 121(3):832–839CrossRef
40.
go back to reference Perez D, Wildi S, Demartines N, Bramkamp M, Koehler C, Clavien PA (2007) Prospective evaluation of vacuum-assisted closure in abdominal compartment syndrome and severe abdominal sepsis. J Am Coll Surg 205(4):586–592CrossRefPubMed Perez D, Wildi S, Demartines N, Bramkamp M, Koehler C, Clavien PA (2007) Prospective evaluation of vacuum-assisted closure in abdominal compartment syndrome and severe abdominal sepsis. J Am Coll Surg 205(4):586–592CrossRefPubMed
41.
go back to reference Berrevoet F, Vanlander A, Sainz-Barriga M et al (2013) Infected large pore meshes may be salvaged by topical negative pressure therapy. Hernia 17:67–73CrossRefPubMed Berrevoet F, Vanlander A, Sainz-Barriga M et al (2013) Infected large pore meshes may be salvaged by topical negative pressure therapy. Hernia 17:67–73CrossRefPubMed
42.
go back to reference Aguilar B, Alyssa B, Chapital MD et al (2010) Conservative management of mesh site infection in hernia repair. J Laparoendosc Adv Surg Tech 20(3):249–252CrossRef Aguilar B, Alyssa B, Chapital MD et al (2010) Conservative management of mesh site infection in hernia repair. J Laparoendosc Adv Surg Tech 20(3):249–252CrossRef
Metadata
Title
Conservative management of mesh-site infection in hernia repair surgery: a case series
Authors
H. Meagher
M. Clarke Moloney
P. A. Grace
Publication date
01-04-2015
Publisher
Springer Paris
Published in
Hernia / Issue 2/2015
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI
https://doi.org/10.1007/s10029-013-1069-8

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