Outcome of patients with chronic mesh infection following abdominal wall hernia repair

Abstract

Mesh infection following incisional hernia repair has been reported at around 6-10%. The aim of this study is to assess the outcome of patients following treatment for chronically infected mesh after repair of an abdominal wall hernia. Data were gathered on all patients with chronically infected mesh following failed conservative management treated under the care of one surgeon between January 2004 and December 2010. This included patient demographics, reason for first operation, number of previous operations and the number of previous hernia repairs. In addition, the type of mesh removed was recorded as was the organism cultured from the wound. Patients were followed up in a clinic at 1month, 3months and 1year after surgery. 15 patients had 18 operations under general anaesthesia for infected mesh (10 partial and 8 complete mesh excisions). The interval between the last mesh implantation or abdominal operation and re-operation for infection was a median of 17months (range 7-49months). All patients who had complete mesh removal had complete healing of their wound at 3months compared with four in the partial excision group (P=0.011). At a median follow-up of 19months, only five in the complete and three in the partial excision group had complete wound healing (P=0.184). The outcome of patients treated for chronic mesh infection is unsatisfactory with high risk of recurrent herniation and development of further chronic abdominal wall sepsis; therefore, every effort should be made to prevent this problem in the first instance.