Infection risk of open placement of intraperitoneal composite mesh

Mesh contamination is the most feared postoperative complication after ventral herniorrhaphy. The morbidity is significant requiring additional operative procedures for debridement or complete removal of the prosthesis. From July 1998 to December 2007, a retrospective review was performed to evaluate the incidence of mesh infection in patients undergoing an elective, open intra-abdominal sublay technique of repair using a composite mesh of polypropylene and expanded polytetrafluoroethylene (Composix, Davol, Inc., Cranston, RI). There were 206 procedures involving open, intraperitoneal placement of Composix mesh resulting in 21 mesh infections (10.2%). The majority of infections were secondary to Staphylococcus aureus contamination (76%), and over half were infected with MRSA. All patients, except two, required mesh removal. Reoperation for repair of the recurrent defect after mesh removal was necessary in 67 per cent. Two patients with MRSA infection subsequently reinfected their recurrent repair. Overall, the infected group required 44 additional procedures (mean of 2.1 procedures/patient). The infection risk was reduced with the lighter density, newer generation composite mesh (7.3% vs 14.5%). Mesh infection after ventral herniorrhaphy conveys significant morbidity. An open intraabdominal underlay of a composite mesh of polypropylene and ePTFE carries a real risk of contamination and should be reconsidered.