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Published on: September 11, 2021
Direct demonstration of bacterial biofilms on prosthetic mesh after ventral herniorrhaphy
Sandeep Kathju1, Laura Nistico, Rachael Melton-Kreft
11 Department of Plastic Surgery, University of Pittsburgh Medical Center , Pittsburgh, Pennsylvania.
Background:
Prosthetic mesh is employed routinely in the treatment of ventral and parastomal hernias, but its use can lead to major complications, including infection, extrusion, and fistula. Bacterial biofilms have been posited to play a role in mesh-related infection, but although bacteria have been noted to form biofilms on mesh surfaces in vitro, they have never been visualized directly in biofilms on mesh recovered from patients experiencing infectious complications.
Methods:
Five patients who developed complications after ventral hernia repair with prosthetic mesh were operated on again. Explanted mesh was examined for biofilm with confocal laser scanning microscopy (CLSM) and fluorescence in situ hybridization (FISH). In two cases, a novel molecular assay (the Ibis T5000) was used to characterize the biofilm-forming bacteria.
Results:
The CLSM examination demonstrated adherent biofilms on mesh surfaces in all five patients. Biofilms also were noted on investing fibrous tissue. The FISH study was able to discriminate between bacterial species in polymicrobial biofilms. In two patients the Ibis T5000 detected more species of constituent biofilm bacteria than did standard culture. Removal of the mesh and reconstruction with autologous tissues or biologic materials resolved the presenting complaints in all cases.
Conclusion:
Bacterial biofilms should be considered an important contributor to the pathology and complications associated with prosthetic mesh implanted in the abdominal wall. If biofilms are present, complete removal of the mesh and repair of the resulting defect without alloplastic materials is an effective intervention.
Insights
Bacterial biofilms were visualized on prosthetic mesh in patients with abdominal wall hernia complications. Complete mesh removal and reconstruction without synthetic materials effectively resolved issues, highlighting biofilms
Area of Science:
- Surgical innovation
- Microbiology
- Biomaterials science
Background:
- Prosthetic mesh is standard for ventral and parastomal hernias but can cause serious complications like infection.
- Bacterial biofilms are suspected in mesh infections but have not been directly visualized on explanted mesh from patients.
Purpose of the Study:
- To visualize and characterize bacterial biofilms on explanted prosthetic mesh from patients with infectious complications.
- To evaluate the role of biofilms in mesh-related abdominal wall hernia complications.
Main Methods:
- Explanted mesh from five patients with hernia repair complications was analyzed using confocal laser scanning microscopy (CLSM) and fluorescence in situ hybridization (FISH).
- A molecular assay (Ibis T5000) was used in two cases to identify biofilm bacteria.
Main Results:
- Adherent biofilms were observed on mesh surfaces and surrounding fibrous tissue in all five patients.
- FISH differentiated bacterial species within polymicrobial biofilms.
- The Ibis T5000 identified more bacterial species than standard cultures in two patients.
Conclusions:
- Bacterial biofilms are a significant factor in prosthetic mesh complications in abdominal wall hernia repair.
- Complete mesh removal and reconstruction using autologous or biologic materials is an effective treatment for biofilm-related complications.
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