Management of late onset septic complications after IPOM implantation: case series from ahernia center

Abstract

The intraperitoneal onlay mesh (IPOM) is for many surgeons apragmatic solution for the operative treatment of extensive and complex abdominal wall hernias. Afew years after mesh implantation we are now faced with anumber of late complications of the IPOM procedure. Chronic septic complications, such as mesh infections and fistula formation have an outstanding position. With this case series we would like to share our experiences with the operative treatment of severe late onset septic complications after abdominal wall augmentation with IPOM. Furthermore, the current indications for the IPOM procedure are discussed. For the period February 2016-July 2019 a total of 10patients with late septic complications after IPOM implantation were treated in our clinic. The index interventions took place between 2010 and 2017. The clinical picture varied from mesh infections with only minor symptoms to formation of multiple intestinal fistulas. Multiple stage procedures were required in 9out of the 10patients in order to achieve sufficient decontamination of the surgical field. Due to enterocutaneous fistulas, bowel resection was performed in 5patients. The mesh could be preserved in situ in only one patient. For the reconstruction of the abdominal wall, both plastic surgical methods and implantation of absorbable and non-absorbable meshes were used. Aconsistent treatment with great effort is required for septic complications of the IPOM procedure. The interventions are often associated with extensive adhesiolysis and intestinal resection. Therefore, the indications for intraperitoneal mesh implantation should be handled with caution and an alternative surgical procedure should be considered. There are still special cases, such as hernias with very large abdominal wall defects in which the IPOM method is asuitable treatment option for tension-free reconstruction.