Maximal Infected Mesh Removal with Methylene Blue Injection for Mesh Infection after Inguinal Hernia Repair

Mesh infection is a serious complication of inguinal hernia repair, but surgeons have not reached a consensus on the method of treatment. The aim of this study was to assess the outcomes of maximal mesh removal therapy with methylene blue injection for mesh infection after inguinal hernia repair. The study was a monocentric retrospective analysis following STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) statements of all patients with mesh infection undergoing maximal mesh removal operation with methylene blue injection. Demographics, mesh infection characteristics, microbiology, early post-operative data, and follow-up data were recorded. Sixteen patients underwent complete removal of infected mesh and 13 had partial removal. The operation time was 76.3 ± 26.0 minutes. In 13 patients the cultures tested positive, five for Staphylococcus aureus. Twelve participants developed surgical site infection post-operatively and eventually healed after 27.4 ± 16.3 days of dressing. In a mean follow-up of 46 months, one patient suffered chronic pain and one had chronic sinus in the partial removal group, although none did in the complete removal group, without a statistically significant difference. No hernia recurrence occurred. Maximal mesh removal therapy with methylene blue injection can be considered as a feasible alternative for the treatment of mesh infection.