C Jin1, Y Shen2, J Chen1. 1. Department of Hernia and Abdominal Wall Surgery, The Capital Medical University Beijing Chaoyang Hospital, Jingyuan Road No. 5, Shijingshan District, Beijing, 100043, China. 2. Department of Hernia and Abdominal Wall Surgery, The Capital Medical University Beijing Chaoyang Hospital, Jingyuan Road No. 5, Shijingshan District, Beijing, 100043, China. shenyingmo@126.com.
Abstract
INTRODUCTION: Mesh infection after inguinal hernioplasty can be complicated especially when it is caused by chronic fistula. Explantation of the infected mesh is inevitable when conservative treatment fails and is considered to be the key step toward development of future therapies. Our purpose was to determine the results of laparoscopic exploration and summarize the treatment experience of the late-onset mesh infection. METHODS: We analyzed 47 patients with late-onset mesh infection treated at our hernia center. The medical records of these patients were retrospectively reviewed, and information regarding presentation, approach of previous hernia repair, type of mesh, operative findings, bacteriological examination result, and postoperative complications were obtained. All of the patients underwent laparoscopic exploration to identify the abscess and fistula, further debridement and treatment was performed afterwards according to the exploration results. RESULTS: All the operative courses were uneventful. Laparoscopy revealed four intestinal fistula and one bladder fistula. Four cases of all underwent debridement and drainage using laparoscopic approach only, and the others were converted to open surgery after laparoscopic exploration to remove the infected mesh. There were two hernia recurrence and nine wound infection during the follow-up period; all the patients had an eventually recovery. CONCLUSIONS: Laparoscopic exploration is an effective and minimally invasive method for managing the late-onset infection which can identify whether internal organ was involved and consult for the further treatment. The approach of mesh removal should be tailored according to the exploration results.
INTRODUCTION:Mesh infection after inguinal hernioplasty can be complicated especially when it is caused by chronic fistula. Explantation of the infected mesh is inevitable when conservative treatment fails and is considered to be the key step toward development of future therapies. Our purpose was to determine the results of laparoscopic exploration and summarize the treatment experience of the late-onset mesh infection. METHODS: We analyzed 47 patients with late-onset mesh infection treated at our hernia center. The medical records of these patients were retrospectively reviewed, and information regarding presentation, approach of previous hernia repair, type of mesh, operative findings, bacteriological examination result, and postoperative complications were obtained. All of the patients underwent laparoscopic exploration to identify the abscess and fistula, further debridement and treatment was performed afterwards according to the exploration results. RESULTS: All the operative courses were uneventful. Laparoscopy revealed four intestinal fistula and one bladder fistula. Four cases of all underwent debridement and drainage using laparoscopic approach only, and the others were converted to open surgery after laparoscopic exploration to remove the infected mesh. There were two hernia recurrence and nine wound infection during the follow-up period; all the patients had an eventually recovery. CONCLUSIONS: Laparoscopic exploration is an effective and minimally invasive method for managing the late-onset infection which can identify whether internal organ was involved and consult for the further treatment. The approach of mesh removal should be tailored according to the exploration results.