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Application of a New Mesh Fixation Method in Laparoscopic Incisional Hernia Repair
Published on: December 23, 2022
Factors affecting salvage rate of infected prosthetic mesh
Jeremy A Warren1, Michael Love2, William S Cobb1
1University of South Carolina School of Medicine Greenville & Prisma Health Upstate, Department of Surgery, Division of Minimally Access & Bariatric Surgery, USA.
Background:
Prosthetic mesh infection (PMI) is a challenging complication of ventral hernia repair (VHR). The sparsity of data leaves only experience and judgment to guide surgical decision-making.
Methods:
Retrospective review of patients diagnosed with PMI. Subsequent abdominal operation (SAO) constitutes any intraabdominal operation occurring after the index hernia repair prior to PMI presentation. Any mesh removal was considered salvage failure. Analysis was performed using Chi-square test, Fishers Exact, or Mann-Whitney U test. Analyses completed using R Version 3.0.2.
Results:
We identified 213 instances of PMI. Most cases (58.7%) involved intraperitoneal mesh. Thirty-seven percent of patients had an SAO, only 25.3% of which were clean cases. Enteroprosthetic fistula occurred in 38 patients (17.8%). Mean time to presentation was 19.9 mos after index hernia repair or SAO for infection alone, and 48.1 mos when a fistula was present (p < 0.001). Percutaneous drainage was used to treat 29 cases, successfully in 10 (34.5%), 8 of which were macroporous polypropylene and 2 biologic mesh. Negative pressure wound therapy (NPWT) was used in 46 patients, but successful in only 16 (34.8%), all of which were macroporous polypropylene. Local wound care alone successfully salvaged only 16 of 85 meshes (18.8%), 13 of which were macroporous polypropylene. Macroporous polypropylene mesh was salvaged in 65% of cases overall, and 72.2% when in an extraperitoneal position. Mesh salvage was not possible in any case involving composite or PTFE mesh, and rarely for microporous polypropylene (7.7%) multifilament polyester (4.2%), or intraperitoneal mesh (2.4%). Closure of the defect after mesh removal significantly lowers recurrence rate (p < 0.001).
Conclusion:
PMI involving composite, PTFE, multifilament polyester, or microporous polypropylene mesh requires explantation in nearly all cases. Infected macroporous polypropylene mesh in an extraperitoneal position is salvageable in most cases. Furthermore, the risk of secondary mesh infection after SAO, particularly with intraperitoneal mesh, should be considered during index VHR.
Insights
Prosthetic mesh infection (PMI) after ventral hernia repair (VHR) is challenging. Macroporous polypropylene mesh, especially in an extraperitoneal position, is often salvageable, unlike other mesh types.
Area of Science:
- Surgical Innovation
- Biomaterials Science
- Infectious Disease Research
Background:
- Prosthetic mesh infection (PMI) is a significant complication following ventral hernia repair (VHR).
- Limited data necessitates reliance on surgical experience for managing PMI.
- Understanding mesh behavior in infected environments is crucial for improving patient outcomes.
Purpose of the Study:
- To analyze outcomes of prosthetic mesh infection (PMI) following ventral hernia repair (VHR).
- To identify factors influencing mesh salvageability and recurrence rates.
- To provide evidence-based guidance for managing PMI.
Main Methods:
- Retrospective review of patients diagnosed with PMI.
- Analysis of subsequent abdominal operations (SAO) and their impact on PMI.
- Statistical analysis using Chi-square, Fisher's Exact, and Mann-Whitney U tests.
Main Results:
- Macroporous polypropylene mesh was salvaged in 65% of cases, particularly in extraperitoneal positions (72.2%).
- Mesh salvage was rarely possible for composite, PTFE, multifilament polyester, or microporous polypropylene meshes.
- Enteroprosthetic fistula occurred in 17.8% of patients, with longer presentation times.
- Defect closure after mesh removal significantly reduced recurrence rates.
Conclusions:
- PMI involving composite, PTFE, multifilament polyester, or microporous polypropylene mesh generally requires explantation.
- Infected macroporous polypropylene mesh in an extraperitoneal location is often salvageable.
- The risk of secondary mesh infection after SAO warrants consideration during index VHR.
