Skip to main content
main-content
Erschienen in: Hernia 5/2018

23.05.2018 | Original Article

Comparison of complete versus partial mesh removal for the treatment of chronic mesh infection after abdominal wall hernia repair

verfasst von: S. Levy, D. Moszkowicz, T. Poghosyan, A. Beauchet, M. -M. Chandeze, K. Vychnevskaia, F. Peschaud, J. -L. Bouillot

Erschienen in: Hernia | Ausgabe 5/2018

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Treatment of chronic mesh infections (CMI) after parietal repair is difficult and not standardized. Our objective was to present the results of a standardized surgical treatment including maximal infected mesh removal.

Methods

Patients who were referred to our center for chronic mesh infection were analyzed according to CMI risk factors, initial hernia prosthetic cure, CMI characteristics and treatments they received to achieve a cure.

Results

Thirty-four patients (mean age 54 ± 13 years; range 23–72), were included. Initial prosthetic cure consisted of 26 incisional hernias and eight groin or umbilical hernias of which 21% were considered potentially contaminated because of three intestinal injuries, two stomas and two strangulated hernias. The mesh was synthetic in all cases. CMI appeared after a mean of 83 days (range 30–6740) and was characterized by chronic leaking in 52 cases (50%), an abscess in 22 cases (21%) and synchronous hernia recurrence in 17 cases (16.5%). Eighty-six reinterventions were necessary, including 36 mesh removals (42%), and 13 intestinal resections for entero-cutaneous fistula (15%). The CMI persistence rate was 81% (35 reinterventions out of 43) when mesh removal was voluntarily limited to infected and/or not incorporated material, but was 44% when mesh removal was voluntarily complete (19 reinterventions out of 43; p < 0.001). On average, 3.4 interventions (1–11) were necessary to achieve a cure, after 2.8 years (0–6). Fourteen incisional hernia recurrences occurred (41%).

Conclusions

Treatment of chronic mesh infection is lengthy and resource-intensive, with a high risk of hernia recurrence. Maximal mesh removal is mandatory.
Literatur
1.
Zurück zum Zitat Luijendijk RW, Hop WC, van den Tol MP, de Lange DC et al (2000) A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med 343(6):392–398 CrossRefPubMed Luijendijk RW, Hop WC, van den Tol MP, de Lange DC et al (2000) A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med 343(6):392–398 CrossRefPubMed
2.
Zurück zum Zitat Kokotovic D, Bisgaard T, Helgstrand F (2016) Long-term recurrence and complications associated with elective incisional hernia repair. JAMA 316(15):1575 CrossRefPubMed Kokotovic D, Bisgaard T, Helgstrand F (2016) Long-term recurrence and complications associated with elective incisional hernia repair. JAMA 316(15):1575 CrossRefPubMed
3.
Zurück zum Zitat Hawn MT, Snyder CW, Graham LA et al (2010) Long-term follow-up of technical outcomes for incisional hernia repair. J Am Coll Surg 210(5):648–657 CrossRefPubMed Hawn MT, Snyder CW, Graham LA et al (2010) Long-term follow-up of technical outcomes for incisional hernia repair. J Am Coll Surg 210(5):648–657 CrossRefPubMed
4.
Zurück zum Zitat Cobb WS, Carbonell AM, Kalbaugh CL et al (2009) Infection risk of open placement of intraperitoneal composite mesh. Am Surg 75(9):762–768 PubMed Cobb WS, Carbonell AM, Kalbaugh CL et al (2009) Infection risk of open placement of intraperitoneal composite mesh. Am Surg 75(9):762–768 PubMed
5.
Zurück zum Zitat Trunzo JA, Ponsky JL, Jin J et al (2009) A novel approach for salvaging infected prosthetic mesh after ventral hernia repair. Hernia 13(5):545–549 CrossRefPubMed Trunzo JA, Ponsky JL, Jin J et al (2009) A novel approach for salvaging infected prosthetic mesh after ventral hernia repair. Hernia 13(5):545–549 CrossRefPubMed
6.
Zurück zum Zitat Alston D, Parnell S, Hoonjan B et al (2013) Conservative management of an infected laparoscopic hernia mesh: a case study. Int J Surg Case Rep 4(11):1035–1037 CrossRefPubMedPubMedCentral Alston D, Parnell S, Hoonjan B et al (2013) Conservative management of an infected laparoscopic hernia mesh: a case study. Int J Surg Case Rep 4(11):1035–1037 CrossRefPubMedPubMedCentral
7.
Zurück zum Zitat Aguilar B, Chapital AB, Madura II et al (2010) Conservative management of mesh-site infection in hernia repair. J Laparoendosc Adv Surg Tech 20(3):249–252 CrossRef Aguilar B, Chapital AB, Madura II et al (2010) Conservative management of mesh-site infection in hernia repair. J Laparoendosc Adv Surg Tech 20(3):249–252 CrossRef
9.
Zurück zum Zitat Akyol C, Kocaay F, Orozakunov E et al (2013) Outcome of the patients with chronic mesh infection following open inguinal hernia repair. J Korean Surg Soc 84(5):287 CrossRefPubMedPubMedCentral Akyol C, Kocaay F, Orozakunov E et al (2013) Outcome of the patients with chronic mesh infection following open inguinal hernia repair. J Korean Surg Soc 84(5):287 CrossRefPubMedPubMedCentral
10.
Zurück zum Zitat Delikoukos S, Tzovaras G, Liakou P et al (2007) Late-onset deep mesh infection after inguinal hernia repair. Hernia 11(1):15–17 CrossRefPubMed Delikoukos S, Tzovaras G, Liakou P et al (2007) Late-onset deep mesh infection after inguinal hernia repair. Hernia 11(1):15–17 CrossRefPubMed
11.
Zurück zum Zitat Fawole AS, Chaparala RP, Ambrose NS (2005) Fate of the inguinal hernia following removal of infected prosthetic mesh. Hernia 10(1):58–61 CrossRefPubMed Fawole AS, Chaparala RP, Ambrose NS (2005) Fate of the inguinal hernia following removal of infected prosthetic mesh. Hernia 10(1):58–61 CrossRefPubMed
12.
Zurück zum Zitat Johanet H, Contival N (2011) Mesh infection after inguinal hernia mesh repair. J Visc Surg 148(5):e392–e394 CrossRefPubMed Johanet H, Contival N (2011) Mesh infection after inguinal hernia mesh repair. J Visc Surg 148(5):e392–e394 CrossRefPubMed
13.
Zurück zum Zitat Bueno-Lledó J, Torregrosa-Gallud A, Carreño-Saénz O et al (2016) Partial versus complete removal of the infected mesh after abdominal wall hernia repair. Am J Surg 214:47–52 (pii: S0002-9610(16)30957-6) CrossRefPubMed Bueno-Lledó J, Torregrosa-Gallud A, Carreño-Saénz O et al (2016) Partial versus complete removal of the infected mesh after abdominal wall hernia repair. Am J Surg 214:47–52 (pii: S0002-9610(16)30957-6) CrossRefPubMed
14.
Zurück zum Zitat Meagher H, Clarke Moloney M, Grace PA (2015) Conservative management of mesh-site infection in hernia repair surgery: a case series. Hernia 19(2):231–237 CrossRefPubMed Meagher H, Clarke Moloney M, Grace PA (2015) Conservative management of mesh-site infection in hernia repair surgery: a case series. Hernia 19(2):231–237 CrossRefPubMed
15.
Zurück zum Zitat Sabbagh C, Verhaeghe P, Brehant O et al (2012) Partial removal of infected parietal meshes is a safe procedure. Hernia 16(4):445–449 CrossRefPubMed Sabbagh C, Verhaeghe P, Brehant O et al (2012) Partial removal of infected parietal meshes is a safe procedure. Hernia 16(4):445–449 CrossRefPubMed
16.
Zurück zum Zitat Breuing K, Butler CE, Ferzoco S et al (2010) Incisional ventral hernias: review of the literature and recommendations regarding the grading and technique of repair. Surgery 148(3):544–558 CrossRefPubMed Breuing K, Butler CE, Ferzoco S et al (2010) Incisional ventral hernias: review of the literature and recommendations regarding the grading and technique of repair. Surgery 148(3):544–558 CrossRefPubMed
18.
Zurück zum Zitat Bueno-Lledó J, Torregrosa-Gallud A, Sala-Hernandez A et al (2017) Predictors of mesh infection and explantation after abdominal wall hernia repair. Am J Surg 213(1):50–57 CrossRefPubMed Bueno-Lledó J, Torregrosa-Gallud A, Sala-Hernandez A et al (2017) Predictors of mesh infection and explantation after abdominal wall hernia repair. Am J Surg 213(1):50–57 CrossRefPubMed
19.
Zurück zum Zitat Chung L, Tse GH, O’Dwyer PJ (2014) Outcome of patients with chronic mesh infection following abdominal wall hernia repair. Hernia 18(5):701–704 CrossRefPubMed Chung L, Tse GH, O’Dwyer PJ (2014) Outcome of patients with chronic mesh infection following abdominal wall hernia repair. Hernia 18(5):701–704 CrossRefPubMed
20.
Zurück zum Zitat Taylor SG, O’Dwyer PJ (1999) Chronic groin sepsis following tension-free inguinal hernioplasty. Br J Surg 86:562–565 CrossRefPubMed Taylor SG, O’Dwyer PJ (1999) Chronic groin sepsis following tension-free inguinal hernioplasty. Br J Surg 86:562–565 CrossRefPubMed
21.
Zurück zum Zitat Fawole AS, Chaparala RP, Ambrose NS (2006) Fate of the inguinal hernia following removal of infected prosthetic mesh. Hernia 10(1):58–61 CrossRefPubMed Fawole AS, Chaparala RP, Ambrose NS (2006) Fate of the inguinal hernia following removal of infected prosthetic mesh. Hernia 10(1):58–61 CrossRefPubMed
22.
Zurück zum Zitat Leber GE, Garb JL, Alexander AI et al (1998) Long-term complications associated with prosthetic repair of incisional hernias. Arch Surg 133(4):378–382 CrossRefPubMed Leber GE, Garb JL, Alexander AI et al (1998) Long-term complications associated with prosthetic repair of incisional hernias. Arch Surg 133(4):378–382 CrossRefPubMed
23.
Zurück zum Zitat Petersen S, Henke G, Freitag M et al (2001) Deep prosthesis infection in incisional hernia repair: predictive factors and clinical outcome. Eur J Surg 167(6):453–457 CrossRefPubMed Petersen S, Henke G, Freitag M et al (2001) Deep prosthesis infection in incisional hernia repair: predictive factors and clinical outcome. Eur J Surg 167(6):453–457 CrossRefPubMed
24.
Zurück zum Zitat Stremitzer S, Bachleitner-Hofmann T, Gradl B et al (2010) Mesh graft infection following abdominal hernia repair: risk factor evaluation and strategies of mesh graft preservation. A retrospective analysis of 476 operations. World J Surg 34(7):1702–1709 CrossRefPubMed Stremitzer S, Bachleitner-Hofmann T, Gradl B et al (2010) Mesh graft infection following abdominal hernia repair: risk factor evaluation and strategies of mesh graft preservation. A retrospective analysis of 476 operations. World J Surg 34(7):1702–1709 CrossRefPubMed
25.
Zurück zum Zitat Berrevoet F, Vanlander A, Sainz-Barriga M et al (2013) Infected large pore meshes may be salvaged by topical negative pressure therapy. Hernia 17(1):67–73 CrossRefPubMed Berrevoet F, Vanlander A, Sainz-Barriga M et al (2013) Infected large pore meshes may be salvaged by topical negative pressure therapy. Hernia 17(1):67–73 CrossRefPubMed
26.
Zurück zum Zitat Shubinets V, Carney MJ, Colen DL et al (2018) Management of infected mesh after abdominal hernia repair: systematic review and single-institution experience. Ann Plast Surg 80(2):145–153 PubMed Shubinets V, Carney MJ, Colen DL et al (2018) Management of infected mesh after abdominal hernia repair: systematic review and single-institution experience. Ann Plast Surg 80(2):145–153 PubMed
27.
Zurück zum Zitat Shankaran V, Weber DJ, Reed RL II (2011) A review of available prosthetics for ventral hernia repair. Ann Surg 253(1):16–26 CrossRefPubMed Shankaran V, Weber DJ, Reed RL II (2011) A review of available prosthetics for ventral hernia repair. Ann Surg 253(1):16–26 CrossRefPubMed
28.
Zurück zum Zitat Mariette C, Briez N, Denies F et al (2013) Use of biological mesh versus standard wound care in infected incisional ventral hernias, the SIMBIOSE study: a study protocol for a randomized multicenter controlled trial. Trials 14:131 CrossRefPubMedPubMedCentral Mariette C, Briez N, Denies F et al (2013) Use of biological mesh versus standard wound care in infected incisional ventral hernias, the SIMBIOSE study: a study protocol for a randomized multicenter controlled trial. Trials 14:131 CrossRefPubMedPubMedCentral
29.
Zurück zum Zitat Conze J, Krones CJ, Schumpelick V et al (2007) Incisional hernia: challenge of re-operations after mesh repair. Langenbecks Arch Surg 392:453–457 CrossRefPubMed Conze J, Krones CJ, Schumpelick V et al (2007) Incisional hernia: challenge of re-operations after mesh repair. Langenbecks Arch Surg 392:453–457 CrossRefPubMed
30.
Zurück zum Zitat Welty G et al (2001) Functional impairment and complaints following incisional hernia repair with different polypropylene meshes. Hernia 5:142–147 CrossRefPubMed Welty G et al (2001) Functional impairment and complaints following incisional hernia repair with different polypropylene meshes. Hernia 5:142–147 CrossRefPubMed
31.
Zurück zum Zitat Weyhe D et al (2007) Improving outcomes in hernia repair by the use of light meshes—a comparison of different implant constructions based on a critical appraisal of the literature. World J Surg 31:234–244 CrossRefPubMed Weyhe D et al (2007) Improving outcomes in hernia repair by the use of light meshes—a comparison of different implant constructions based on a critical appraisal of the literature. World J Surg 31:234–244 CrossRefPubMed
32.
Zurück zum Zitat Schmidbauer S et al (2005) Heavy-weight versus low-weight polypropylene meshes for open sublay mesh repair of incisional hernia. Eur J Med Res 10:247–253 PubMed Schmidbauer S et al (2005) Heavy-weight versus low-weight polypropylene meshes for open sublay mesh repair of incisional hernia. Eur J Med Res 10:247–253 PubMed
33.
Zurück zum Zitat den Hartog D, Dur AH, Tuinebreijer WE et al (2008) Open surgical procedures for incisional hernias. Cochrane Database Syst Rev 3:CD006438 den Hartog D, Dur AH, Tuinebreijer WE et al (2008) Open surgical procedures for incisional hernias. Cochrane Database Syst Rev 3:CD006438
34.
Zurück zum Zitat Szczerba SR, Dumanian GA (2003) Definitive surgical treatment of infected or exposed ventral hernia mesh. Ann Surg 237(3):437–441 PubMedPubMedCentral Szczerba SR, Dumanian GA (2003) Definitive surgical treatment of infected or exposed ventral hernia mesh. Ann Surg 237(3):437–441 PubMedPubMedCentral
35.
Zurück zum Zitat Akyol C, Kocaay F, Orozakunov E et al (2013) Outcome of the patients with chronic mesh infection following open inguinal hernia repair. J Korean Surg Soc 84(5):287–291 CrossRefPubMedPubMedCentral Akyol C, Kocaay F, Orozakunov E et al (2013) Outcome of the patients with chronic mesh infection following open inguinal hernia repair. J Korean Surg Soc 84(5):287–291 CrossRefPubMedPubMedCentral
Metadaten
Titel
Comparison of complete versus partial mesh removal for the treatment of chronic mesh infection after abdominal wall hernia repair
verfasst von
S. Levy
D. Moszkowicz
T. Poghosyan
A. Beauchet
M. -M. Chandeze
K. Vychnevskaia
F. Peschaud
J. -L. Bouillot
Publikationsdatum
23.05.2018
Verlag
Springer Paris
Erschienen in
Hernia / Ausgabe 5/2018
Print ISSN: 1265-4906
Elektronische ISSN: 1248-9204
DOI
https://doi.org/10.1007/s10029-018-1785-1