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Updated: Jun 20, 2026
Application of a New Mesh Fixation Method in Laparoscopic Incisional Hernia Repair
Published on: December 23, 2022
Infection risk of open placement of intraperitoneal composite mesh
William S Cobb1, Alfredo M Carbonell, Corey L Kalbaugh
1Hernia Center, Greenville Hospital System University Medical Center, Department of Surgery, Greenville, South Carolina 29605, USA. wcobb@ghs.org
Abstract:
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.
Insights
Ventral herniorrhaphy using intraperitoneal composite mesh led to a 10.2% infection rate, primarily from Staphylococcus aureus. This complication significantly increases morbidity and requires further procedures, suggesting reconsideration of this technique.
Area of Science:
- Surgical Innovation
- Infectious Disease Epidemiology
- Biomaterials Science
Background:
- Mesh contamination is a significant postoperative complication following ventral herniorrhaphy.
- Infections necessitate further operative procedures for debridement or prosthesis removal, increasing patient morbidity.
Purpose of the Study:
- To evaluate the incidence of mesh infection in patients undergoing elective, open intra-abdominal sublay repair with a composite mesh.
- To assess the impact of mesh type and contamination on postoperative outcomes.
Main Methods:
- Retrospective review of 206 procedures involving open, intraperitoneal placement of a composite mesh (polypropylene and expanded polytetrafluoroethylene).
- Analysis of infection rates, causative pathogens (Staphylococcus aureus, MRSA), and subsequent management including mesh removal and reoperation.
Main Results:
- A 10.2% mesh infection rate was observed (21 out of 206 procedures).
- Staphylococcus aureus was the primary pathogen (76%), with over half of infections involving MRSA.
- Mesh removal was required in all but two patients, with 67% needing reoperation for recurrent defects. Lighter density mesh showed a reduced infection risk (7.3% vs. 14.5%).
Conclusions:
- Mesh infection after ventral herniorrhaphy results in substantial morbidity and a high rate of reoperation.
- The open intra-abdominal underlay technique using composite mesh carries a significant risk of contamination and should be reconsidered.
- Further research into infection prevention and alternative repair methods is warranted.
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