The salvage of mesh infection after hernia repair with the use of negative pressure wound therapy (NPWT), a systematic review

Abstract

Background: Mesh infection is the most feared postoperative complication after abdominal wall hernia repair, often needs mesh removal. Negative pressure wound therapy (NPWT) has been used in these situations with diverse results. The aim of this study was to investigate the efficacy of the NPWT in the treatment of mesh infection, the primary outcome was the mesh salvage rates of different type of meshes and mesh positions. Methods: Major databases were searched using the keywords negative pressure wound therapy, VSD, vacuum assisted, hernia, mesh infection, including various combinations of the terms. All relevant articles and reference lists in these original studies were also obtained from the above databases. Results: Ten articles containing 265 patients on the treatment of mesh infection after hernia repair with the use of NPWT method were included. The general infected mesh salvage rate with NPWT was 76.2%. The highest mesh salvage rate was achieved in polypropylene mesh (93.5%), followed by Proceed mesh (83.3%), and the mesh salvage rate was lower in polyester mesh (PCO) (0%) and the ePTFE mesh (14/3%). The salvage rate was higher when mesh placed in the onlay position (82.6%) or retromuscular/sublay position (98.5%), but lower in the IPOM position (55.6%). Conclusion:The treatment of mesh infection after hernia repair should be individualized according to the mesh type, mesh position and the severity of infection. Infected mesh with favourable mesh materials (large pore and monofilament polypropylene) and favourable positions (onlay or sublay/retromuscular) can be salvaged with the use of NPWT based conservative method.

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

“…Local wound care salvaged only 18.8% of meshes, of which 80% were macroporous polypropylene [54]. The potential salvageability of polypropylene related to other prosthetic mesh formulations has been confirmed by others [55,60]. The relative difference in salvageability of a mesh is again related to the sizes of the pores, the weave of the mesh, and its anatomic position.…”

“…A large review of vacuum-assisted closure therapy with infected mesh confirmed the highest salvage with polypropylene mesh (93.5%), intermediate with composite (83.3%), and none with PTFE. Furthermore, onlay (83%) and retromuscular (98.5%) had higher rates of salvage than IPOM (56%) [60].…”

“…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]. Warren and colleagues concluded that mesh properties and position within the abdominal wall were the primary determinants regarding salvage of infected mesh.…”

Polyglactin 910 Meshes Coated with Sustained-Release Cannabigerol Varnish Inhibit Staphylococcus aureus Biofilm Formation and Macrophage Cytokine Secretion: An In Vitro Study

“…Currently, nonsurgical treatment options for mesh infections are limited and include the systemic administration of antibiotics. Frequently, the infection of mesh necessitates its removal [ 10 , 11 ]. It has been reported that almost 70% of mesh explantations are associated with infection [ 1 ].…”