Hernia mesh infection: a surgical disaster

Abstract

Mesh infection is one of most disastrous complication following hernia surgery. The consequences are more complex especially following a laparoscopic hernia repair operation. Understanding the pathophysiology of mesh infections is pivotal in adopting preventive strategies. Once infected, exact determination of the extent of the septic complication by CECT is essential. A two staged surgical intervention yields excellent results. A case of infected laparoscopic mesh repair treated by a two staged operation is presented along with a brief review of literature to highlight the safety and efficacy of this approach.

Colonic incarceration in an adult umbilical hernia: case report and review of literature

“…migration and infection of the mesh are prevented as the mesh lies sandwiched between the two aponeurotic layers. 12 The operative technique described in the case report therefore, provides a three layered protection over the defect, thereby reducing the recurrence rate to a bare minimum.…”

“…Placement of a mesh is essential in umbilical hernia repair. 11,12 Suture techniques such as primary suturing or Mayo's repair have a high incidence of recurrence. This is best provided by placing a mesh on the newly created midline extending laterally into the retro rectus space.…”

“…This is best provided by placing a mesh on the newly created midline extending laterally into the retro rectus space. 12 This provides a twofold advantage viz. migration and infection of the mesh are prevented as the mesh lies sandwiched between the two aponeurotic layers.…”

Clinically available reinforcing materials for soft tissue reconstruction

“…Synthetic polymers harbour infections by accumulation and formation of a biofilm on the surface of the polymer (Sanchez et al, 2011). While not common in clean surgical procedures, when synthetic polymer mesh does become infected, the treatment often requires surgical removal of the mesh with devastating consequences as a result of the need to excise large areas of tissue (Hawn et al, 2011;Sanchez et al, 2011;Vagholkar et al, 2016). With degradable synthetic polymers, the risks appear similar until the material is degraded and absorbed and therefore can vary by the absorption time (Sahoo et al, 2017;Stoikes et al, 2017).…”

Infections associated with mesh repairs of abdominal wall hernias: Are antimicrobial biomaterials the longed-for solution?

“…Nevertheless, hernia repair using either suture or mesh technique can result in infectious complications [1,2], with incidence rates between 1 and 4% of all patients. Hernia mesh-related infection is "a surgical disaster" [3], with dramatic effects for the patients and incurs significant healthcare costs. Considering that more than 1 million hernia repair operations using mesh are performed annually in the USA, it is estimated that approximately 60 000 inguinal and ventral hernia (corresponding to protrusion through the inguinal canal or through the muscles of the abdominal wall respectively) repairs become infected annually, with similar numbers in Europe [4].…”