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Mesh Infection After Hernia Repair and Negative Pressure Wound Therapy. A Systematic Review
Jose Bueno-Lledó1, Jesús Martinez-Hoed2, Santiago Bonafe-Diana3
1Unit of Abdominal Wall Surgery. Department of Digestive Surgery, La Fe" Hospital University of Valencia, Calle Gabriel Miró 28, Puerta 12, 46008, Valencia, Spain. buenolledo@hotmail.com.
Background:
Surgical mesh infection (SMI) after abdominal wall hernia repair (AWHR) is a challenging and highly debated clinical problem with no current consensus. The purpose of this review was to analyze the literature about the use of negative pressure wound therapy (NPWT) in the management of the conservative treatment of SMI and report results about infected mesh salvage.
Methods:
A systematic review of EMBASE and PUBMED was performed describing the use of NPWT in patients with SMI following AWHR. Reviewed articles evaluating data about the association between clinical, demographic, analytic and surgical characteristics about SMI after AWHR were analyzed. The high heterogeneity of these studies did not allow a meta-analysis of outcomes.
Results:
The search strategy yielded 33 studies from PubMed, and 16 studies from EMBASE. NPWT was performed in 230 patients across 9 studies being achieved the mesh salvage in 196 (85.2%). Of these 230 cases, 46% were polypropylene (PPL), 9.9% polyester (PE), 16.8% polytetrafluoroethylene (PTFE), 4% biologic and 10.2% composite mesh (PPL and PTFE). Infected mesh location was onlay (43%), retromuscular (22%), preperitoneal (19%), intraperitoneal (10%) and between the oblique muscles (5%). The better option on salvageability with the use of NPWT was the combination of macroporous PPL mesh in an extraperitoneal position (19.2% onlay, 23.3% preperitoneal, 48.8% retromuscular).
Conclusion:
NPWT is a sufficient approach to treat SMI following AWHR. In most cases, infected prostheses can be salvaged with this management. Further studies with a larger sample size are needed to confirm our analysis results.
Insights
Negative pressure wound therapy (NPWT) effectively manages surgical mesh infection (SMI) after abdominal wall hernia repair (AWHR), often salvaging infected meshes. Further research is needed to confirm these findings in larger patient groups.
Area of Science:
- Surgical Innovation
- Wound Management
- Biomaterials in Surgery
Background:
- Surgical mesh infection (SMI) following abdominal wall hernia repair (AWHR) presents a significant clinical challenge with no established consensus on management.
- Conservative treatment strategies for SMI are debated, highlighting the need for effective interventions.
Purpose of the Study:
- To systematically review the literature on the use of negative pressure wound therapy (NPWT) for the conservative management of SMI.
- To analyze outcomes related to infected mesh salvage in patients undergoing AWHR.
Main Methods:
- A systematic review of EMBASE and PubMed databases was conducted.
- Studies focusing on NPWT in patients with SMI after AWHR were analyzed for clinical, demographic, and surgical characteristics.
- High heterogeneity precluded a meta-analysis of outcomes.
Main Results:
- NPWT was applied to 230 patients across 9 studies, successfully salvaging infected mesh in 196 (85.2%).
- Polypropylene (PPL) mesh, particularly macroporous types in an extraperitoneal position (onlay, preperitoneal, retromuscular), showed better salvageability with NPWT.
- Various mesh types (PPL, polyester, PTFE, biologic, composite) and locations were analyzed.
Conclusions:
- Negative pressure wound therapy (NPWT) is a viable approach for treating SMI after AWHR.
- Infected prostheses can frequently be salvaged using NPWT.
- Larger studies are recommended to validate these findings and solidify treatment protocols.
