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Comment on: Conservative management of an infected laparoscopic hernia mesh: A case study
Duncan Alston1, Stephanie Parnell1, Bhupinder Hoonjan1
1Department of Vascular Surgery, Colchester General Hospital, Turner Road, Colchester CO4 5JL, United Kingdom.
Introduction:
We recently published an article in this journal describing the successful conservative treatment of a patient with an infected laparoscopically inserted hernia mesh using gentamycin flushes via a pig-tail drain and long term oral antibiotics. This prevented the need for major reconstructive surgery. However, 3 months after we published our report, the patient re-presented with symptoms of a recurrence of infection.
Presentation Of Case:
Seven months after stopping oral antibiotics, our patient represented with fever and swelling and redness over his left sided inguinal hernia mesh. This mesh had to be surgically removed. The procedure was laparoscopic and showed infection confined to the central 5cm of the mesh. Microbiology culture results were the same as on initial presentation.
Discussion:
The microbiology results suggest that it is likely that the infection was never fully eradicated and that our intervention merely kept the infection at bay. Once long term antibiotics were stopped it is likely that the infection was able to eventually recur.
Conclusion:
Consequently, we have been unable to show that our method of conservative management of infected hernia meshes is effective to prevent long term recurrence of infection.
Insights
Conservative treatment for infected hernia mesh, using gentamycin flushes and antibiotics, failed to prevent long-term infection recurrence. The infection returned after antibiotic treatment cessation, necessitating mesh removal.
Area of Science:
- Surgical infection management
- Hernia repair complications
- Antimicrobial therapy efficacy
Background:
- A previous study detailed successful conservative treatment of infected hernia mesh using gentamycin flushes and oral antibiotics.
- This approach aimed to avoid major reconstructive surgery for infected mesh complications.
Discussion:
- Despite initial success, the patient experienced infection recurrence 3 months after stopping oral antibiotics.
- Surgical removal revealed infection confined to the mesh, with identical microbiology results to the initial presentation.
- This suggests the infection was not fully eradicated and conservative management only temporarily controlled it.
Key Insights:
- Conservative management of infected hernia mesh may not achieve complete eradication.
- Cessation of antibiotic therapy can lead to infection recurrence.
- Recurrent infection necessitates surgical intervention and mesh removal.
Outlook:
- Further research is needed to explore more effective long-term strategies for infected hernia mesh.
- Investigating alternative or combination therapies may be crucial for preventing recurrence.
- Evaluating the role of mesh material and surgical techniques in infection susceptibility is warranted.
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