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Late-onset deep mesh infection after inguinal hernia repair
S Delikoukos1, G Tzovaras, P Liakou
1Department of Surgery, Larissa University Hospital, 9 Papakiriazi Street, Larissa, 41 223, Greece. morfula@otenet.gr
Background:
Groin sepsis requiring mesh removal is said to be a rare complication of tension-free inguinal hernioplasty. Furthermore, late-onset deep-seated prosthetic infection seems to be an unexpected complication. The aim of this study was to report our experience on late mesh infection occurring years after open hernia repair.
Methods:
Between 1998 and 2005, 1,452 patients (954 men), median age 64 years (range 19-89) underwent groin hernioplasty using a tension-free polypropylene mesh technique. Five patients (0.35%) appeared with late mesh infection (between 2 and 4.5 years postoperatively). The patients' records were retrospectively reviewed for the purpose of this study. Antibiotic prophylaxis had been given in the five patients, while none of them had a prior history of wound infection.
Results:
The patients were re-operated and the meshes were removed. Pus was found in three patients and Staphylococcus aureus was isolated in one. There was no hernia recurrence and none of the patients had chronic groin pain for a period of 6-44 months postoperatively.
Conclusion:
From the results of this study, it appears that late-onset deep-seated prosthetic mesh infection is an important complication which has been rarely reported upon. Its true incidence is yet to be established. Late graft infection does not seem to correlate to neither the administration or not of antibiotic prophylaxis, nor to the presence or not of previous superficial wound infection. Furthermore, graft infection does not seem to correlate to neither the type of mesh inserted, nor to the fixation material. With the increasing use of synthetic materials for primary and recurrent hernia repair, the number of patients presenting with late mesh infections is likely to increase.
Insights
Late mesh infection after inguinal hernia repair is a rare but serious complication. This study highlights its occurrence years post-surgery, emphasizing the need for awareness in prosthetic hernia repair.
Area of Science:
- Surgical complications
- Infectious diseases
- Biomaterials in surgery
Background:
- Tension-free inguinal hernioplasty using polypropylene mesh can lead to groin sepsis requiring mesh removal.
- Late-onset, deep-seated prosthetic infection is an unexpected complication of these procedures.
- This study reports on late mesh infections occurring years after open hernia repair.
Purpose of the Study:
- To report the experience with late mesh infections after open hernia repair.
- To analyze the characteristics and outcomes of patients with late mesh infections.
- To contribute to the understanding of this rare complication.
Main Methods:
- Retrospective review of 1,452 patients who underwent tension-free inguinal hernioplasty between 1998 and 2005.
- Analysis of five patients (0.35%) who presented with late mesh infection between 2 and 4.5 years postoperatively.
- Review of patient records, including antibiotic prophylaxis and prior wound infection history.
Main Results:
- Five patients developed late mesh infections, with pus found in three and Staphylococcus aureus isolated in one.
- All patients underwent re-operation with mesh removal.
- No hernia recurrence or chronic groin pain was observed postoperatively (6-44 months).
Conclusions:
- Late-onset deep-seated prosthetic mesh infection is a significant, rarely reported complication of inguinal hernioplasty.
- The true incidence of late mesh infection requires further investigation.
- Antibiotic prophylaxis, prior superficial wound infection, mesh type, and fixation material did not appear to correlate with late graft infection.
- The increasing use of synthetic materials suggests a potential rise in late mesh infections.
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