Predictors of mesh infection and explantation after abdominal wall hernia repair

Bueno-Lledó, José; Torregrosa-Gallud, Antonio; Sala-Hernández, Angela; Carbonell-Tatay, Fernando; Pastor, Providencia García; Diana, Santiago Bonafé; Hernández, José Iserte

doi:10.1016/j.amjsurg.2016.03.007

Cited by 75 publications

(40 citation statements)

References 31 publications

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“…Indeed, immunosuppressive drugs such as steroids were identified as risk factors for the infection or explantation of synthetic meshes. 3 Surgical mesh removal often implicates an array of serious health impairments (e.g. prolonged recovery, decrease in function, recurrence, pain) and social consequences (e.g.…”

Section: Introductionmentioning

confidence: 99%

Operative outcome of hernia repair with synthetic mesh in immunocompromised patients

Lee

Stroux

Nickisch³

et al. 2020

ANZ Journal of Surgery

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Background: The safety of synthetic mesh in elective hernia repair in the setting of immunosuppression lacks national and international consensus. The aim of our analysis was to explore the effects of immunosuppression on the rates of wound complications. Methods: Comparative analysis of immunocompetent and immunocompromised patients with elective mesh repair of inguinal, femoral, primary ventral, incisional or parastomal hernia between January 2001 and December 2013. Immunosuppression included glucocorticoids, biologicals, chemotherapy and chemoradiotherapy. Primary outcome parameter was mesh infection rate. Follow-up questionnaires were completed in written form or by telephone interview. Results: Questionnaire response rate was 59.5% (n = 194) with a median follow-up of 33 (interquartile range: 28-41) months. There were no differences between immunocompromised (n = 40, 20.6%) and immunocompetent patients (n = 154, 79.4%) based on hernia and patient characteristics. Immunosuppression was not associated with the rates of mesh infection (P = 1.000), surgical site infection (SSI, P = 0.330) or re-operation for SSI (P = 0.365), but with higher rates (P = 0.007) and larger odds for hernia recurrence (odds ratio 3.264, 95% confidence interval 1.304-8.172; P = 0.012). Mesh infection also increased the odds for hernia recurrence (odds ratio 11.625; 95% confidence interval 1.754-77.057; P = 0.011). Only in the subset of ventral/incisional hernias, immunocompromised (n = 8, 40%) patients had higher recurrence rates than immunocompetent patients (n = 5, 11.6%; P = 0.017). Patients with SSI reported more frequently moderate to severe dysesthesia at the surgical site (P = 0.013) and would less frequently re-consent to surgery (P = 0.006). Conclusion: Immunosuppression does not increase the rate of wound infections after elective hernia repair with synthetic mesh. However, immunosuppression and mesh infection are risk factors for hernia recurrence.

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Section: Introductionmentioning

confidence: 99%

Operative outcome of hernia repair with synthetic mesh in immunocompromised patients

Lee

Stroux

Nickisch³

et al. 2020

ANZ Journal of Surgery

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“…Mesh infection and explantation are reported in the literature but are highly heterogeneous. As recent large systematic review, reported the mesh infection and explantation rates at 1.9% and 1.2%, respectively, after the repair of Ventral hernia working group (VHWG) grade I and II hernias 24. For contaminated hernias, mesh infection and explantation rates have been reported at 38% and 5%, respectively, after biological mesh implantation 25.…”

Section: Discussionmentioning

confidence: 99%

Intraluminal mesh migration causing enteroenteric and enterocutaneous fistula: a case and discussion of the ‘mesh problem’

et al. 2018

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The use of synthetic mesh in the abdominal compartment has recently become a topic of debate as high profile public cases have called into question their safety. Several case reports have demonstrated significant complications due to intra-abdominal mesh. Furthermore, some studies have suggested that the rates of these severe complications are underestimated. We present the case of a patient who developed an enteroenteric and enterocutaenous fistulae, an abdominal wall collection and an intraperitoneal inflammatory mass from intraluminal migration of a synthetic mesh inserted during laparoscopic incisional hernia repair. We discuss the considerations and complications of using synthetic mesh for ventral hernia repair and discuss the scientific evidence behind the increasingly apparent 'mesh problem'.

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“…Indeed, resident surgeons (non-expert in the field of hernia repair) require more time to perform the procedure, which directly impacts the risk of SSI [15,30e32]. Other important factors include the size of the implanted mesh (higher risk if mesh surface is above 300 cm 2 ) [15,32], its architecture (higher risk when multifilament or dense membrane (such as expanded form of polytetrafluoroethylene (ePTFE) compared to porous monofilament structures) [15,19,28,33,34] or the presence of drainage placed intra-operatively in order to prevent the accumulation of fluid when placed for more than 3 days [35]. Patient demographics also influences the risk of developing mesh infection, as for other surgical fields, including smoking [12,36,37], existence of chronic pulmonary disease [31] or diabetes [38], along with patient age [12] and obesity [14,15].…”

Section: Incidence Of Ssi In Herniatologymentioning

confidence: 99%

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

Guillaume

Pérez‐Tanoira

Fortelny³

et al. 2018

Biomaterials

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The incidence of mesh-related infection after abdominal wall hernia repair is low, generally between 1 and 4%; however, worldwide, this corresponds to tens of thousands of difficult cases to treat annually. Adopting best practices in prevention is one of the keys to reduce the incidence of mesh-related infection. Once the infection is established, however, only a limited number of options are available that provides an efficient and successful treatment outcome. Over the past few years, there has been a tremendous amount of research dedicated to the functionalization of prosthetic meshes with antimicrobial properties, with some receiving regulatory approval and are currently available for clinical use. In this context, it is important to review the clinical importance of mesh infection, its risk factors, prophylaxis and pathogenicity. In addition, we give an overview of the main functionalization approaches that have been applied on meshes to confer anti-bacterial protection, the respective benefits and limitations, and finally some relevant future directions.

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Predictors of mesh infection and explantation after abdominal wall hernia repair

Cited by 75 publications

References 31 publications

Operative outcome of hernia repair with synthetic mesh in immunocompromised patients

Operative outcome of hernia repair with synthetic mesh in immunocompromised patients

Intraluminal mesh migration causing enteroenteric and enterocutaneous fistula: a case and discussion of the ‘mesh problem’

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

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