PWE-394 Are we misdiagnosing foreign body reaction to biologic implants as mesh-related infection?

Abstract

Introduction Concern regarding mesh erosion has led to the increased use of biological implants in laparoscopic ventral rectopexy (LVR). There is a growing recognition that biological implants are not inert and their introduction into the body triggers a sequence of events leading to the formation of foreign body giant cells at the tissue/implant interface. This could lead to systemic inflammatory response syndrome (SIRS) that mimics mesh-related infection. Method The records of 4 patients readmitted after LVR were assessed retrospectively. A radiologist with an interest in pelvic floor surgery reviewed their CT scans. Results We performed 27 LVRs from October 2013–2014 using Biodesign®biological implant and 19 using synthetic mesh. 4 patients (15%) from the biologic cohort were re-admitted with pain and pyrexia and a pelvic abscess was suspected. CRP was raised in 4 (mean 276 at readmission and 99 at discharge) but in only one was the WCC elevated. All 4 received antibiotics and 2 patients had percutaneous drainage of sterile collections while the other two had no intervention. Those treated with drainage had a longer hospital stay and a delayed recovery compared with the observation only group. All made a complete recovery and none had either symptoms of their original prolapse or dysfunctional defecation. None of the patients in the synthetic mesh group were readmitted. Conclusion SIRS is a natural reaction to the implantation of non-inert foreign material as evidenced by elevated inflammatory mediators in the absence of a neutrophilia. This small study would suggest that the drainage of such 9collections9 following insertion of biological meshes is not only unnecessary but may run the risk of introducing sepsis into a sterile environment. The routine use of intravenous antibiotics might be unnecessary and a watchful waiting approach should be considered. Disclosure of interest None Declared.