Management of Infected Mesh After Lichtenstein Hernia Repair: a Systematic Review

Abstract

Inguinal hernia repair with mesh is one of the most common operations performed by general surgeons. Mesh infection is a rare complication that has detrimental effects on the patient and the healthcare system. The purpose of this systematic review was to determine an evidence-based management approach for patients with infected mesh following an open Lichtenstein inguinal hernia repair. The literature search was achieved using the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines (PRISMA). The quality of the papers was assessed using Grading of Recommendations Assessment Development and Evaluation (GRADE) criteria. Studies were analysed by two independent reviewers. A total of 1532 abstracts and articles were reviewed. Fourteen met the inclusion criteria. In most, the mesh used was either monofilament or multifilament polypropylene. Most (86.8%) underwent mesh removal despite attempts at conservative management. Universally, in the presence of sinus formation (infected mesh to skin), mesh removal was required for definite resolution of infection. After a period of conservative management, removal of infected mesh following Lichtenstein inguinal hernia repair may be recommended. However, the quality of evidence is poor. Techniques such as partial removal or use of negative pressure dressings may need to be further explored.