Incidence Of Mesh Infection Research Articles

LAPAROSCOPIC MESH EXPLANTATION FOR MESH INFECTIONS FOLLOWING INTRA PERITONEAL ON-LAY MESHPLASTY (IPOM): A CASE SERIES

The introduction of synthetic mesh has become the standard of care in the management of abdominal wall hernias [1,2]. However, the slightest of breach in the sterility chain can lead to mesh infection and biolm formation which often requires a prolonged stay in hospital with long term use of antibiotics and need for multiple interventions. Incidence of mesh infection is dependent on both Intra-operative events as well as pre-existing modiable risk factors in the patient. Mesh infection can present as abscess, chronic discharging sinus and sepsis [1] However, in most cases, mesh explantation is required. In this paper, we present a series of 5 patients who underwent laparoscopic mesh explantation following IPOM mesh infection with good outcomes.

Open Inguinal Hernia Repair: Incidence of Mesh Infection

Introduction: Wound and mesh infections after inguinal hernia repair are very severe complications. Today it is an established fact to repair hernias with meshes in various ways to prevent or delay the recurrence of hernia, but knowledge regarding the incidence of mesh infection is rare. The aim of the study was to assess the incidence of mesh infection in Open Inguinal Hernia Repair. Methods: This retrospective study was conducted at the Department of Surgery, Sylhet M.A.G Osmani Medical College, Sylhet, Bangladesh during the period from January 2020 to December 2021. The study included 400 patients who underwent mesh repair for inguinal hernia repair during the 2 years period. Among the total 400 patients, 24 were diagnosed with mesh related infections. Mesh related infections influenced by type of mesh use; surgical techniques and underlying comorbidity were all recorded. Both medical and surgical management required for mesh infection were also recorded. Use of antimicrobial included coverage of staphylococcus. Laparoscopic hernia repair cases were excluded from the study. Result: The study found 24 mesh related infection in a total of 400 patients who underwent open inguinal hernia repair. The overall mesh related infection rate was 3%. The infection was established at a variable delay after mesh insertion, with 40% delayed onset after procedure and 60% diagnosed during the first post-operative month. Infection was cured in 6 patients after mesh removal. Conclusion: Mesh removal appears to be one of the appropriate treatments for this rare and serious complication. The most common pathogen was Staphylococcus aureus and E. Coli. The possibility of a mesh related infection remains active weeks or even years after initial hernia repair. If mesh infection develops it should be treated vigorously and mesh should be excised early if necessary.

Mesh infection in cases of polypropylene mesh hernioplasty.

Mesh hernioplasty is the most common surgery for hernia repair with Polypropylene mesh as the preferred one. But the use of synthetic prosthesis is associated with the inherited risk of developing a prosthetic infection that may manifest even after a very long time as subtle symptoms in the form of fever, myalgia, erythema of overlying skin and in some cases as chronic discharging sinus. With this in view a systematic prospective observational study has been carried out to estimate the incidence of mesh infections, to identify the type of associated organism and to study the outcome of the cases with hernioplasty using Propylene mesh. Mesh hernioplasty performed in all adult patients using propylene mesh exclusively on 161 males and 20 females were considered in this prospective observational study carried out for 3years (2016-2019) at tertiary care centre and teaching hospital in India. A standard size of the propylene mesh and well laid procedures were used for surgery as well as post operative care, identification and culture of microorganism. The patients were followed up to identify any symptoms of SSI or mesh infection. The entire data was statistically analyzed using Statistical Package for Social Sciences (SPSS ver 21.0, IBM Corporation, USA) for MS Windows. Out of 181 cases, the mesh contamination was observed in 59 cases while total cases of mesh infection were nine (09), which include 07 males and 02 females. The cases that developed infection were of mostly groin hernias. The cases commonly presenting with erythema, seroma and surgical wound dehiscence with identification of methicillin sensitive Staphylococcus aureus (MSSA) in the few samples of the wound discharge were managed conservatively and none of the cases had to undergo mesh explantation. Of the numerous factors viz. age, sex, associated co-morbidities, educational status, socio-economic status, duration of surgery and expertise of the operating surgeon, the two factors viz. duration of surgery and the mesh contamination were found to be associated with mesh infection in a statistically significant way. The incidence of mesh infection was observed in 4.97% of total 181 cases. To the best of knowledge, this seems to be the first prospective observational carried out in this country. Of the numerous factors studied, the duration of surgery and mesh contamination were the factors found to have statistical significance on the incidence of mesh infection. Although a clear picture to differentiate surgical site infection from acute mesh infection is yet to be obtained, the study provided better understanding of the management as no mesh explantation was required in either of the cases.

Laparoscopic Management of Prosthetic Infections Following Laparoscopic Groin Hernioplasty — Experiences from a Tertiary Care Center

Despite increasing trends towards laparoscopic groin hernioplasty, its early prosthesis-related complications have hardly been addressed. Although conventionally treated by an open approach, we describe our experience with the laparoscopic management of infected meshes. We retrospectively evaluated 9 patients (5 were referred and 4 from our center) with groin abscesses due to infected meshes following laparoscopic hernioplasty from January 2003 to 2015 in whom surgical intervention was deemed necessary. One patient had his mesh migrated into the urinary bladder, which was laparoscopically removed. The mean operative time was 76 minutes and mean hospital stay was 7.5 days. All the infected meshes were removed laparoscopically via endobags without any conversions. One patient had MRSA mesh infection and 1 had tuberculosis, both of whom recovered completely with the appropriate antimicrobial therapy. One patient had chronic groin pain following infected mesh extraction that lasted for 10 months while one patient developed a recurrent hernia that was managed by open anatomical repair. The mean follow-up was 28 months. Mesh infections are classified as complicated and uncomplicated, and treatment depends on the type of infection type. Complicated mesh infections following laparoscopic groin hernioplasty often dictate mesh removal, requiring large incisions and the high morbidity of the open approach. However, optimal laparoscopic techniques for such patients would drastically diminish the morbidity and physiological insult without compromising surgical principles. Although large-volume studies are not possible as the incidence of mesh infection is very low, our series supports the feasibility of a laparoscopic approach in these difficult circumstances.

Concomitant Laparoscopic Ventral Hernia Mesh Repair and Bariatric Surgery: A Retrospective Study from a Tertiary Care Center

To analyze the safety in combing laparoscopic ventral hernia repair with a mesh and bariatric surgery. Obesity is one of the important precipitating factors for primary and recurrent ventral hernias (incisional and umbilical) and it is not uncommon to find these hernias in patients opting for obesity surgery. But, with no consensus or recommendation and concern of mesh infection, surgeons fear in combining these procedures, especially Roux en Y gastric bypass and sleeve gastrectomy. In this study, we have retrospectively analyzed all patients who underwent concomitant bariatric procedure and mesh repair for ventral hernia at our institute. A total of 36 out of 765 patients operated at our institute between 2003 and 2011 had concomitant procedures. Eleven patients had Roux en Y gastric bypass (group I) and remaining 25 had sleeve gastrectomy (group II) performed on them. The operating times were 149 min(120-210 min) in group I and 122 min (90-220min) in group II. No immediate complications or any incidence of mesh infection or recurrence in either of the groups. Concomitant mesh repair for ventral hernias can be safely combined with bariatric procedures like Roux en Y gastric bypass and sleeve gastrectomy. But, for beginners, these should be done only in selected cases after fully informed consent from the patients.

Mesh Infection in the Era of Laparoscopy

The incidence of mesh infection during open hernia repair has been reported to be as high as 3%. With the introduction of laparoscopy, the rate of infection is still a matter of debate. All 1182 laparoscopic inguinal hernia repairs performed at our institution from September 1991 to June 2002 were retrospectively reviewed to identify both mesh and wound infections. There were two mesh infections (0.17%) during that period, and one wound infection. The incidence of mesh infection in laparoscopic repair is considerably lower than in the open procedure. The two main reasons for this are the introduction of mesh through trocars to avoid skin contact, and the mesh is placed far from the trocar incisions, again avoiding contamination. The rate of wound infection is not related to that of mesh infection, and depends mainly on aseptic prepping techniques prior to surgery.

Mesh Infection in the Era of Laparoscopy

Background: The incidence of mesh infection during open hernia repair has been reported to be as high as 3%. With the introduction of laparoscopy, the rate of infection is still a matter of debate. Methods: All 1182 laparoscopic inguinal hernia repairs performed at our institution from September 1991 to June 2002 were retrospectively reviewed to identify both mesh and wound infections. Results: There were two mesh infections (0.17%) during that period, and one wound infection. Conclusion: The incidence of mesh infection in laparoscopic repair is considerably lower than in the open procedure. The two main reasons for this are the introduction of mesh through trocars to avoid skin contact, and the mesh is placed far from the trocar incisions, again avoiding contamination. The rate of wound infection is not related to that of mesh infection, and depends mainly on aseptic prepping techniques prior to surgery.

Repair of paracolostomy hernias with a prosthetic mesh in the intraperitoneal onlay position: modified Sugarbaker technique.

The disappointing outcome of local fascial repair and stoma relocation in parastomal hernias has stimulated a variety of new techniques that use a prosthetic mesh for herniorrhaphy. Many of these procedures either carry the risk of mesh contamination or allow only a local repair. We established a method that allows both an aseptic operation and the management of concurrent incisional hernias. In a retrospective study we evaluated all patients who had undergone operation for a paracolostomy hernia with an expanded polytetrafluoroethylene (PTFE) mesh in the intraperitoneal onlay position in our Department of General Surgery from 1994 until 2002. Twenty patients with large paracolostomy hernias and 10 additional ventral hernias, mostly large incisional or recurrent incisional hernias, were identified. We combined the Sugarbaker and the Rives-Stoppa techniques by covering the defects with an ePTFE mesh after laparotomy and fixing the mesh with traction sutures. Postoperatively, there was no incidence of mesh infection. After a mean follow-up of 3 1/2 years we found three recurrences of paracolostomy hernias and two recurrences of incisional hernias. Another two hernias emerged in the previously intact midline. All these hernias were small, without tendency to enlargement, and did not warrant reoperation. Patients with symptomatic paracolostomy hernias or a combination of abdominal wall defects should properly be managed surgically with an intraperitoneally placed mesh that covers all hernias. Our results, with a recurrence rate of only 15 percent for the parastomal site and 20 percent for combined defects, support this approach.