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Inguinal hernia mesh infections: Chronic challenges, atypical pathogens and lessons in sterilisation

Debaraj S Purkayastha1, Anowar A Mallick2, Gautam Das3

  • 1Junior Resident, Department of General Surgery, IPGMER and SSKM Hospital, Kolkata, India.

Tropical Doctor
|January 13, 2025
PubMed

Insights

Chronic mesh infections post-inguinal hernia repair are challenging due to resistant bacteria and diagnostic difficulties. Complete mesh removal and targeted therapy resolved infections in four patients, highlighting needs for better sterilization and diagnostics.

Area of Science:

  • Infectious Diseases
  • Surgical Innovation
  • Microbiology

Background:

  • Chronic mesh infections following inguinal hernia repair pose significant clinical challenges.
  • Biofilm formation, multidrug-resistant organisms, and atypical pathogens contribute to treatment resistance.
  • Current preventive strategies for mesh infections are insufficient.

Purpose of the Study:

  • To highlight critical research gaps in managing chronic mesh infections.
  • To investigate the role of atypical pathogens, such as *Mycobacterium tuberculosis*, in post-hernia repair infections.
  • To emphasize the need for improved diagnostic and sterilization protocols.

Main Methods:

  • A case series of four patients with chronic mesh infections after inguinal hernia repair was analyzed.
  • Microbiological analyses were performed to identify causative pathogens.
  • Treatment outcomes were evaluated based on complete mesh removal and culture-directed antimicrobial therapy.

Main Results:

  • Identified pathogens included *Pseudomonas aeruginosa*, *Klebsiella pneumoniae*, *Mycobacterium tuberculosis*, and mixed flora.
  • Patients experienced persistent sinuses and recurrent hernias, indicating diagnostic and treatment challenges.
  • Complete mesh removal combined with targeted antimicrobial therapy led to resolution in all cases within 8-12 months.

Conclusions:

  • Chronic mesh infections require robust sterilization protocols and advanced diagnostic methods.
  • The role of atypical pathogens in these infections should be further investigated.
  • Development of biofilm-resistant biomaterials is crucial for preventing future mesh infections.
Keywords:
Inguinal hernia repairbiofilm-resistant biomaterialsbiofilmsprosthetic mesh infectionsterilisationsurgical mesh removal

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