Staged approach to chronic mesh infection following hernia repair: a single-center experience
Abstract
Purpose: To investigate the outcomes of a two-staged approach involving mesh explantation surgery in patients with chronic mesh infection (CMI) following hernia repair.
Methods: A retrospective review of patients who underwent mesh explantation for CMI after ventral and inguinal hernia repair (2011-2019) using electronic database records.
Results: Sixty-four patients (41 M, 23 F) included in this study had a mean age and BMI of 46.5 and 26.7, respectively. The most commonly isolated organism was Staphylococcus aureus (23.5%). Complete mesh explantation was performed in 41 patients, partial in 17, and debridement in 5 others. One patient underwent single-stage hernia mesh repair using biological mesh. Among the other 63, 22 (35%) had recurrent hernia after mesh explantation (mean follow-up: 4 years), 14 underwent hernia mesh repair, and eight were lost to follow-up; 41 (65%) remained recurrence-free after mesh explantation over a mean follow-up of 4 years (SD +/- 2.18 years). The recurrence rate after mesh explantation was significantly lower in patients with inguinal hernias (16%, 4/25) than in those with ventral hernias (46.2%, 18/39; p = 0.046).
Conclusion: Chronic mesh infections following hernia repair pose a formidable challenge to surgeons. It is better handled at specialized centers. We suggest complete mesh explantation in such patients and staged repair in the event of a hernia recurrence.
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 41 participants or records.
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