Management of Mesh Infection

Abstract

Among the most feared complications associated with repair of abdominal wall hernias is prosthetic mesh infection. This can potentially result in a cycle of reoperations, repeated infections, and recurrent hernias. Repair without mesh reinforcement, however, results in unacceptably high rates of recurrence. There are more than 100 commercially available mesh products available for use in ventral hernia repair (VHR), and there are multiple options for operative approach, mesh positioning within the abdominal wall, securement of the mesh material, and component separation techniques (CST). Additionally, each material has unique physiomechanical and biocompatibility profiles that determine their clinical response to infection. This makes any true conclusions as to the optimal management of prosthetic mesh infection difficult, and leaves the surgeon with little more than personal experience and clinical judgment to guide the care of these challenging complications. This chapter aims to review the available literature and provide guidance in the operative and nonoperative management of mesh infection, and prevention of this potentially devastating complication.