S Levy1, D Moszkowicz2,3, T Poghosyan1,4, A Beauchet5, M -M Chandeze1, K Vychnevskaia1, F Peschaud1,4, J -L Bouillot1,4. 1. AP-HP, Department of Digestive, Oncologic and Metabolic Surgery, Ambroise Paré Hospital, 9 Av Charles de Gaulle, 92104, Boulogne-Billancourt Cedex, France. 2. AP-HP, Department of Digestive, Oncologic and Metabolic Surgery, Ambroise Paré Hospital, 9 Av Charles de Gaulle, 92104, Boulogne-Billancourt Cedex, France. david.moszkowicz@aphp.fr. 3. Versailles St-Quentin-en-Yvelines/Paris Saclay University, UFR des sciences de la santé Simone Veil, 78180, Montigny-Le-Bretonneux, France. david.moszkowicz@aphp.fr. 4. Versailles St-Quentin-en-Yvelines/Paris Saclay University, UFR des sciences de la santé Simone Veil, 78180, Montigny-Le-Bretonneux, France. 5. AP-HP, Department of Biostatistics, Ambroise Paré Hospital, Boulogne-Billancourt, France.
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.
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.
Authors: José Bueno-Lledó; Antonio Torregrosa-Gallud; Angela Sala-Hernandez; Fernando Carbonell-Tatay; Providencia G Pastor; Santiago B Diana; José I Hernández Journal: Am J Surg Date: 2016-06-01 Impact factor: 2.565
Authors: Mary T Hawn; Christopher W Snyder; Laura A Graham; Stephen H Gray; Kelly R Finan; Catherine C Vick Journal: J Am Coll Surg Date: 2010-05 Impact factor: 6.113
Authors: Adam S Levy; Jaime L Bernstein; Ishani D Premaratne; Christine H Rohde; David M Otterburn; Kerry A Morrison; Michael Lieberman; Alfons Pomp; Jason A Spector Journal: Surg Endosc Date: 2020-05-08 Impact factor: 4.584