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

Guillaume, Olivier; Pérez‐Tanoira, Ramón; Fortelny, R.; Redl, Heinz; Moriarty, T. Fintan; Richards, R. Geoff; Eglin, David; Puchner, A. Petter

doi:10.1016/j.biomaterials.2018.03.017

Cited by 74 publications

(67 citation statements)

References 135 publications

(208 reference statements)

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“…The recurrence rate of repaired hernia has been reduced marginally by using synthetic PP implants [2][3][4]. However, after PP mesh implantation, infection can be rare (1%-4%) [5,6], but subsequent failure of hernia mesh devices cannot be undervalued [7,8]. Reasons for infection may be the colonization of bacteria of the uneven knitting surfaces of PP meshes which may cause fistula formation around its pore size and result in the formation of granuloma [9].…”

Section: Introductionmentioning

confidence: 99%

Chitosan Cross-Linked Bio-based Antimicrobial Polypropylene Meshes for Hernia Repair Loaded with Levofloxacin HCl via Cold Oxygen Plasma

Sanbhal

Khatri

et al. 2019

Coatings

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Polypropylene (PP) large pore size nets have been most widely used implants for hernia repair. Nevertheless, the growth of bacteria within PP mesh pores after operation is a major reason of hernia recurrence. Secondly, pre-operative prophylaxis during mesh implantation has failed due to the hydrophobic nature of PP meshes. Herein, chitosan cross-linked and levofloxacin HCl incorporated, antimicrobial PP mesh devices were prepared using citric acid as a bio-based and green cross-linking agent. The inert PP mesh fibers were surface activated using O2 plasma treatment at low pressure. Then, chitosan of different molecular weights (low and medium weight) were cross-linked with O2 plasma activated surfaces using citric acid. Scanning electron microscopy (SEM), energy dispersive X-ray (EDX) spectroscopy, and Fourier transform infrared (FTIR) spectroscopy confirmed that chitosan was cross-linked with O2 plasma-treated PP mesh surfaces and formed a thin layer of chitosan and levofloxacin HCl on the PP mesh surfaces. Moreover, antimicrobial properties of chitosan and levofloxacin HCl-coated PP meshes were investigated using an agar plate release method. The coated PP meshes demonstrated excellent antimicrobial inhibition zone up to 10 mm. Thus, modified PP meshes demonstrated sustained antimicrobial properties for six continuous days against Staphylococcus aureus (SA) and Escherichia coli (EC) bacteria.

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Section: Introductionmentioning

confidence: 99%

Chitosan Cross-Linked Bio-based Antimicrobial Polypropylene Meshes for Hernia Repair Loaded with Levofloxacin HCl via Cold Oxygen Plasma

Sanbhal

Khatri

et al. 2019

Coatings

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“…One of the emerging trends is to combine antimicrobial coatings to the mesh to be implanted [ 8 ]. This local and controlled administration of drugs reduces the risk of developing bacterial resistance and permits to achieve high concentration of therapeutics in the vicinity of the prosthesis with limited or no systemic effect [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Thermo-Responsive Antimicrobial Hydrogel for the In-Situ Coating of Mesh Materials for Hernia Repair

et al. 2020

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The prophylactic coating of prosthetic mesh materials for hernia repair with antimicrobial compounds is commonly performed before implantation of the mesh in the abdominal wall. We propose a novel alternative, which is a rifampicin-loaded thermo-responsive hydrogel formulation, to be applied on the mesh after its implantation. This formulation becomes a gel in-situ once reached body temperature, allowing an optimal coating of the mesh along with the surrounding tissues. In vitro, the hydrogel cytotoxicity was assessed using rabbit fibroblasts and antimicrobial efficacy was determined against Staphylococcus aureus. An in vivo rabbit model of hernia repair was performed; implanted polypropylene meshes (5 × 2 cm) were challenged with S. aureus (106 CFU), for two study groups—unloaded (n = 4) and 0.1 mg/cm2 rifampicin-loaded hydrogel (n = 8). In vitro, antibacterial activity of the hydrogel lasted for 5 days, without sign of cytotoxicity. Fourteen days after implantation, meshes coated with drug-free hydrogel developed a strong infection and resulted in poor tissue integration. Coating meshes with the rifampicin-loaded hydrogel fully prevented implant infection and permitted an optimal tissue integration. Due to its great performance, this, degradable, thermo-responsive antimicrobial hydrogel could potentially be a strong prophylactic armamentarium to be combined with prosthesis in the surgical field.

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“…However, infection, rejection, seroma, intestinal adhesion, intestinal obstruction and other complications caused by mesh have become new clinical problems [6,7]. According to statistics, the incidence of mesh infection after abdominal hernia repair was 1 ~ 4% [8], among which the mesh infection rate after inguinal hernia repair by open surgery was about 1.0% ~ 9.1% [9], while that of MILIHR was 0.7%-2% [10]. Although the infection rate of mesh is low, postoperative mesh infection is the most serious postoperative complication, and the clinical treatment is a di cult and thorny problem.…”

Section: Introductionmentioning

confidence: 99%

The Clinical Characteristics and Treatment of Mesh Infection After Laparoscopic Inguinal Hernia Repair

Luo

Chongshu

2020

Preprint

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Background: Mesh infection after inguinal hernia repair (MILIHR) is one of the rare and most serious complications. The aim of our study was to analyze the clinical characteristics and treatment methods of MILIHR.Methods: Two MILIHR cases admitted to Beibei Traditional Chinese Medical Hospital were reported, and 32 MILIHR cases reported in Chinese and English literatures were retrieved. The clinical features and treatment of MILIHR in 34 cases were analyzed.Results: In case 1, medical glue was found in in the infected area, and in case 2, the infection focal point was the residual hernia sac covering the pus. Risk factors of other cases included obesity, smoking, malignant tumor, diabetes, postoperative hematoma, postoperative aspiration of seroma, steroid or immunosuppressive drugs use, etc. The results of pathogen culture showed that there were 14 cases of Staphylococcus, 5 cases of Escherichia coli, 5 cases of Pseudomonas, 1 case of Hemolytic streptococcus, 2 cases of fungi, 2 cases of pseudoinfection (rejection). 33 cases were cured after the mesh was removed, and 1 case was cured after conservative treatment. The mesh was removed by laparoscopic surgery in 22 cases and by open surgery in 11 cases.Conclusions: The risk factors of MILIHR are multifactorial，and the using of medical glue and residual hernia sac may be the risk factors of mesh infection. The main pathogens of MILIHR were Staphylococcus, Escherichia coli and Pseudomonas. The most reliable way to treat MILIHR is to remove the mesh completely. The removal of the infected mesh by laparoscopic surgery can clearly identify the important anatomical structures and avoid anterior approach abdominal wall damage during re-hernia repair.

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

Cited by 74 publications

References 135 publications

Chitosan Cross-Linked Bio-based Antimicrobial Polypropylene Meshes for Hernia Repair Loaded with Levofloxacin HCl via Cold Oxygen Plasma

Chitosan Cross-Linked Bio-based Antimicrobial Polypropylene Meshes for Hernia Repair Loaded with Levofloxacin HCl via Cold Oxygen Plasma

Thermo-Responsive Antimicrobial Hydrogel for the In-Situ Coating of Mesh Materials for Hernia Repair

The Clinical Characteristics and Treatment of Mesh Infection After Laparoscopic Inguinal Hernia Repair

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