It all doesn’t always have to go: abdominal wall reconstruction involving selective synthetic mesh explantation with biologic mesh salvage

Abstract

Summary The comparative performance of synthetic and biologic meshes in complex and contaminated abdominal wall repairs remains controversial. Though biologic meshes are generally favoured in contaminated fields, this practice is based on limited data. Standard dictum regarding infected mesh is to either explant it early or pursue aggressive conservation measures depending on mesh position and composition. Explantation is typically morbid, leaving the patient with recurrent hernias and few reconstructive options. We report a case in which a hernia repaired with synthetic mesh recurred and was reconstructed with underlay biologic mesh. Delayed wound hematoma occurred after initiating anticoagulation for late postoperative pulmonary embolism, which became chronically infected. After multiple failed attempts at medical and interventional salvage of the mesh infection, the patient underwent selective explantation of synthetic mesh with conservation of the underlying biological mesh. She recovered completely without recurrent abdominal wall failure at long-term follow-up. We suggest the “salvageable” characteristics of biologic meshes may allow conservation, rather than explantation, in select cases of infection.

The Effect of Bowel Anastomosis on Outcomes in Complex Abdominal Wall Reconstruction

“…Synthetic mesh and biologic mesh are both good options in the treatment of ventral abdominal wall defects. Biologics are felt to reduce infection rates in higher-risk patients, although cost and recurrent bulge can be higher than synthetic alternatives 19,20 . Biosynthetic mesh and synthetic mesh have been found not to increase the risk of early complications and may reduce hernia recurrences and improve long-term outcomes after CAWR 20–24 .…”

“…Biologics are felt to reduce infection rates in higher-risk patients, although cost and recurrent bulge can be higher than synthetic alternatives. 19,20 Biosynthetic mesh and synthetic mesh have been found not to increase the risk of early complications and may reduce hernia recurrences and improve long-term outcomes after CAWR. [20][21][22][23][24] In a study of synthetic mesh use in the presence of open bowel, complication rates were demonstrated to be 47%, on par with the literature when using biologic mesh in these patients.…”

Are Surgeons Going to Be Left Holding the Bag? Incisional Hernia Repair and Intra-Peritoneal Non-Absorbable Mesh Implant Complications

“…It has been conventionally taught that management of a PMI will mandate removal of the mesh [14,55]. In practice, however, this often equates to multiple reoperations, complex wound care, and the development of a recurrent hernia potentially larger than even the inciting defect [54,59]. Depending on the location and mesh type, it may be possible to salvage some meshes using antibiotics, interventional radiology, conservative surgical debridement, and negative pressure wound therapy [15,55,60].…”