Mesh Infection in Ventral Incisional Hernia Repair: Incidence, Contributing Factors, and Treatment

Boston University, Boston, Massachusetts, United States
Surgical Infections (Impact Factor: 1.45). 06/2011; 12(3):205-10. DOI: 10.1089/sur.2011.033
Source: PubMed


Prosthetic mesh infection is a catastrophic complication of ventral incisional hernia (VIH) repair.
The current surgical literature was reviewed to determine the incidence, microbiology, risk factors, and treatment of mesh infections.
Mesh infections tend to present late. Diagnosis depends on high clinical suspicion and relies on culture of the fluid surrounding the mesh or of the mesh itself. Risk factors may include a high body mass index (obesity); chronic obstructive pulmonary disease; abdominal aortic aneurysm repair; prior surgical site infection; use of larger, microporous, or expanded polytetrafluoroethylene mesh; performance of other procedures via the same incision at the time of repair; longer operative time; lack of tissue coverage of the mesh; enterotomy; and enterocutaneous fistula. The best treatment is prevention. Treatment of mesh infection is evolving on a case-by-case basis from explantation toward mesh salvage, to prevent complications such as hernia recurrence.
Higher-quality reporting on mesh infection in VIH repair must be achieved through better classification and quantification of these infections. Tactics to avoid mesh infection should be based on best evidence and high-quality prospective trials and observational studies.

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    • "). Various kinds of synthetic implants are used to repair incisional hernia and abdominal wall defects, including biodegradable and non-degradable mesh, however, there are limitations with these materials (van der Linden and van Vroonhoven, 1988; Cassar and Munro, 2002; Dumanian and Denham, 2003; den Hartog et al., 2008; Sanchez et al., 2011). For example, synthetic meshes should not be used in patients with previous wound infections, abdominal fistula or immunosuppression because of a high infection risk. "
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