Mesh infection in ventral incisional hernia repair: incidence, contributing factors, and treatment.

BACKGROUND: Prosthetic mesh infection is a catastrophic complication of ventral incisional hernia (VIH) repair.
METHODS: The current surgical literature was reviewed to determine the incidence, microbiology, risk factors, and treatment of mesh infections.
RESULTS: Mesh infections tend to present late. Diagnosis depends on high clinical suspicion and relies on culture of the fluid surrounding the mesh or of the mesh itself. Risk factors may include a high body mass index (obesity); chronic obstructive pulmonary disease; abdominal aortic aneurysm repair; prior surgical site infection; use of larger, microporous, or expanded polytetrafluoroethylene mesh; performance of other procedures via the same incision at the time of repair; longer operative time; lack of tissue coverage of the mesh; enterotomy; and enterocutaneous fistula. The best treatment is prevention. Treatment of mesh infection is evolving on a case-by-case basis from explantation toward mesh salvage, to prevent complications such as hernia recurrence.
CONCLUSION: Higher-quality reporting on mesh infection in VIH repair must be achieved through better classification and quantification of these infections. Tactics to avoid mesh infection should be based on best evidence and high-quality prospective trials and observational studies.