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Partial versus complete removal of the infected mesh after abdominal wall hernia repair
José Bueno-Lledó1, Antonio Torregrosa-Gallud1, Omar Carreño-Saénz1
1Surgical Unit of Abdominal Wall, Department of Digestive Surgery, "La Fe" Universitary Hospital, University of Valencia, Valencia, Spain.
Background:
To compare the results with complete mesh removal (CMR) versus partial mesh removal (PMR) in the treatment of mesh infection after abdominal wall hernia repair (AWHR).
Methods:
Retrospective review of all patients who underwent surgery for mesh infection between January 2004 and May 2014 at a tertiary center.
Results:
Of 3470 cases of AWHR, we reported 66 cases (1.9%) of mesh infection, and 48 repairs (72.7%) required mesh explantation. CMR was achieved on 38 occasions, while PMR was undertaken ten times. We observed more postoperative complications in CMR than PMR group (p = 0.04). Three patients with intestinal fistula were reoperated in postoperative period after a difficult mesh removal; one of them died due to multiple organ failure. The overall recurrence rate after explantation was 47.9%: recurrence was more frequent in CMR group (p = 0.001), although persistent or new mesh infection was observed more frequently with PMR (p = 0.001).
Conclusions:
Although PMR has less postoperative morbidity, shorter duration of hospitalization and lower rate of recurrence than CMR, prosthetic infection persists in up to 50% of cases.
Insights
Complete mesh removal (CMR) for abdominal wall hernia repair (AWHR) infections led to more complications and recurrence than partial mesh removal (PMR). However, PMR resulted in higher rates of persistent infection.
Area of Science:
- Surgical outcomes
- Hernia repair complications
- Mesh infection management
Background:
- Mesh infection is a complication of abdominal wall hernia repair (AWHR).
- Treatment options include complete mesh removal (CMR) and partial mesh removal (PMR).
Purpose of the Study:
- To compare the outcomes of CMR versus PMR in treating mesh infections after AWHR.
Main Methods:
- Retrospective review of patients with mesh infection after AWHR between January 2004 and May 2014.
- Analysis of surgical outcomes, complications, recurrence rates, and persistent infection.
Main Results:
- Mesh explantation was required in 72.7% of 66 mesh infections.
- Complete mesh removal (CMR) was associated with more postoperative complications (p=0.04) and higher recurrence rates (p=0.001) compared to partial mesh removal (PMR).
- Partial mesh removal (PMR) showed a higher rate of persistent or new mesh infection (p=0.001).
Conclusions:
- Partial mesh removal (PMR) offers benefits like reduced postoperative morbidity, shorter hospitalization, and lower recurrence rates.
- Despite these advantages, prosthetic infection persists in up to 50% of cases following PMR.
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