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Kirkpatrick AW, Coccolini F, Tolonen M, Minor S, Catena F, Celotti A, Gois E, Perrone G, Novelli G, Garulli G, Ioannidis O, Sugrue M, De Simone B, Tartaglia D, Lampella H, Ferreira F, Ansaloni L, Parry NG, Colak E, Podda M, Noceroni L, Vallicelli C, Rezende-Netos J, Ball CG, McKee J, Moore EE, Mather J. Are Surgeons Going to Be Left Holding the Bag? Incisional Hernia Repair and Intra-Peritoneal Non-Absorbable Mesh Implant Complications. J Clin Med 2024; 13:1005. [PMID: 38398318 PMCID: PMC10889414 DOI: 10.3390/jcm13041005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 01/29/2024] [Accepted: 01/31/2024] [Indexed: 02/25/2024] Open
Abstract
Ventral incisional hernias are common indications for elective repair and frequently complicated by recurrence. Surgical meshes, which may be synthetic, bio-synthetic, or biological, decrease recurrence and, resultingly, their use has become standard. While most patients are greatly benefited, mesh represents a permanently implanted foreign body. Mesh may be implanted within the intra-peritoneal, preperitoneal, retrorectus, inlay, or onlay anatomic positions. Meshes may be associated with complications that may be early or late and range from minor to severe. Long-term complications with intra-peritoneal synthetic mesh (IPSM) in apposition to the viscera are particularly at risk for adhesions and potential enteric fistula formation. The overall rate of such complications is difficult to appreciate due to poor long-term follow-up data, although it behooves surgeons to understand these risks as they are the ones who implant these devices. All surgeons need to be aware that meshes are commercial devices that are delivered into their operating room without scientific evidence of efficacy or even safety due to the unique regulatory practices that distinguish medical devices from medications. Thus, surgeons must continue to advocate for more stringent oversight and improved scientific evaluation to serve our patients properly and protect the patient-surgeon relationship as the only rationale long-term strategy to avoid ongoing complications.
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Affiliation(s)
- Andrew W. Kirkpatrick
- Regional Trauma Services, Department of Surgery, Critical Care Medicine, University of Calgary, Calgary, AB T2N 2T9, Canada
- TeleMentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group, University of Calgary, Calgary, AB T3H 3W8, Canada
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, 56124 Pisa, Italy;
| | - Matti Tolonen
- Emergency Surgery Department, HUS Helsinki University Hospital, 00029 Helsinki, Finland;
| | - Samual Minor
- Department of Surgery and Critical Care Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada;
| | - Fausto Catena
- Head Emergency and General Surgery Department, Bufalini Hospital, 47521 Cesena, Italy; (F.C.); (C.V.)
| | | | - Emanuel Gois
- Department of Surgery, Londrina State University, Londrina 86038-350, Brazil;
| | - Gennaro Perrone
- Department of Emergency Surgery, Parma University Hospital, 43125 Parma, Italy;
| | - Giuseppe Novelli
- Chiurgia Generale e d’Urgenza, Osepedale Buffalini Hospital, 47521 Cesna, Italy;
| | | | - Orestis Ioannidis
- 4th Department of Surgery, Medical School, Aristotle University of Thessaloniki, General Hospital “George Papanikolaou”, 57010 Thessaloniki, Greece;
| | - Michael Sugrue
- Letterkenny University Hospital, F92 AE81 Donegal, Ireland;
| | - Belinda De Simone
- Unit of Emergency Minimally Invasive Surgery, Academic Hospital of Villeneuve-Saint-Georges, 91560 Villeneuve-Saint-Georges, France;
| | - Dario Tartaglia
- Emergency and General Surgery Unit, New Santa Chiara Hospital, University of Pisa, 56126 Pisa, Italy;
| | - Hanna Lampella
- Gastrointestinal Surgery Unit, Helsinki University Hospital, Helsinki University, 00100 Helsinki, Finland;
| | - Fernando Ferreira
- GI Surgery and Complex Abdominal Wall Unit, Hospital CUF Porto, Faculty of Medicine of the Oporto University, 4200-319 Porto, Portugal;
| | - Luca Ansaloni
- San Matteo Hospital of Pavia, University of Pavia, 27100 Pavia, Italy;
| | - Neil G. Parry
- Department of Surgery and Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 3K7, Canada;
| | - Elif Colak
- Samsun Training and Research Hospital, University of Samsun, 55000 Samsun, Turkey;
| | - Mauro Podda
- Department of Surgical Science, University of Cagliari, 09124 Cagliari, Italy;
| | - Luigi Noceroni
- Hospital Infermi Rimini, 47923 Rimini, Italy; (G.G.); (L.N.)
| | - Carlo Vallicelli
- Head Emergency and General Surgery Department, Bufalini Hospital, 47521 Cesena, Italy; (F.C.); (C.V.)
| | - Joao Rezende-Netos
- Trauma and Acute Care Surgery, General Surgery, St. Michael’s Hospital, University of Toronto, Toronto, ON M5T 1P8, Canada;
| | - Chad G. Ball
- Acute Care, and Hepatobiliary Surgery and Regional Trauma Services, University of Calgary, Calgary, AB T2N 1N4, Canada; (C.G.B.); (J.M.)
| | - Jessica McKee
- TeleMentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group, University of Calgary, Calgary, AB T3H 3W8, Canada
| | - Ernest E. Moore
- Ernest E Moore Shock Trauma Center at Denver Health, Denver, CO 80204, USA;
| | - Jack Mather
- Acute Care, and Hepatobiliary Surgery and Regional Trauma Services, University of Calgary, Calgary, AB T2N 1N4, Canada; (C.G.B.); (J.M.)
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Zhi Z, Liu R, Han W, Cui H, Li X. Quality of life assessment of patients after removal of late-onset infected mesh following open tension-free inguinal hernioplasty: 3-year follow-up. Hernia 2023; 27:1525-1531. [PMID: 37528329 DOI: 10.1007/s10029-023-02845-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 07/23/2023] [Indexed: 08/03/2023]
Abstract
PURPOSE Open tension-free inguinal hernioplasty is one of the common surgical methods used today to treat inguinal hernias due to its simplicity and low recurrence rate. With the widespread use of tension-free inguinal hernia repair, the number of patients with mesh infections is gradually increasing. However, there is a lack of studies assessing the quality of life of patients after the removal of late-onset infected meshes in open inguinal hernias. The aim of this study was to analyse and assess the quality of life, pain severity and anxiety of patients after late-onset infection mesh removal following open inguinal hernioplasty. METHODS Data from 105 patients admitted to our hospital from January 2014 to January 2019 who developed delayed mesh infection after open tension-free inguinal hernia repair were retrospectively analysed. 507 patients without mesh infection after open inguinal hernioplasty were included as cross-sectional controls. The baseline data of the two groups were matched for propensity score matching (PSM) with a caliper value of 0.05 and a matching ratio of 1:1. Patients are followed up by telephone or outpatient consultations for 3 years to assess quality of life, pain and anxiety after removal of the infected mesh. RESULTS The 105 patients who developed late-onset mesh infection after inguinal hernia repair had a mean age of 64.07 ± 12.90 years and a mean body mass index (BMI) of 24.64 ± 2.67 (kg/m2). The mean follow-up time was 58 months and 10.5% (10/105) of the patients were lost to follow-up. At the 3-year follow-up there was one case of hernia recurrence and five cases of mesh reinfection. The patients' quality of life scores, pain scores and anxiety scores improved after surgery compared to the preoperative scores (all p < 0.01). CONCLUSION Patients with late-onset mesh infection after inguinal hernioplasty showed an improvement in quality of life, pain and anxiety compared to preoperative after removal of the infected mesh. Mesh-plug have a higher risk of mesh infection due to their poor histocompatibility and tendency to crumple and shift.
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Affiliation(s)
- Z Zhi
- Yan'an University, Yan'an, 716000, China
- Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, China
| | - R Liu
- Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, China
| | - W Han
- Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, China
| | - H Cui
- Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, China
| | - X Li
- Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, China.
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Hajibandeh S, Qayum MK, Hajibandeh S, Bodkhe K, Nawaz G, Faridi N, Peixoto D, Kar I. Complete Versus Partial Excision of an Infected Mesh Following Abdominal Wall Hernia Repair: A Systematic Review and Meta-analysis. Am Surg 2023; 89:4344-4352. [PMID: 35722833 DOI: 10.1177/00031348221109816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND To evaluate comparative outcomes of complete and partial excision of infected mesh following abdominal wall hernia repair. METHODS A systematic search of electronic databases, including MEDLINE, EMBASE, CINAHL, and CENTRAL, and bibliographic reference lists with application of a combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators and limits was conducted. Surgical site infection chronic sinus formation, recurrent hernia, and need for reoperation were the evaluated outcome measures. RESULTS Six comparative observational studies were identified, reporting a total of 317 patients of whom 193 underwent complete mesh excision and the remaining 123 patients underwent partial mesh excision for an infected mesh following abdominal wall hernia repair. The complete mesh excision was associated with significantly lower rates of SSIs (OR: .36; 95% CI, .16-.81, P = .01), chronic sinus formation (OR: .11; 95% CI, .02-.71, P = .02), and reoperation (OR: .10; 95% CI, .03-.33, P = .0001) compared to the partial mesh excision. There was no significant difference in hernia recurrence rate (OR: 3.96.16, 95% CI .62-25.44, P = .15) between two groups. The between-study heterogeneity was moderate in all the analyses. CONCLUSIONS Complete mesh excision may be associated with lower SSI, chronic sinus formation and need for reoperation when compared to the partial mesh excision in an infected mesh event. However, the available evidence has failed to report the outcomes with respect to the main confounding factors which, together with other important outcomes such as fistula formation, should be considered by future high quality research.
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Affiliation(s)
- Shahin Hajibandeh
- Hepatobiliary and Pancreatic Surgery Unit, Queen Elizabeth Hospital, Birmingham, UK
| | - Mohammed K Qayum
- Department of General Surgery, Hereford County Hospital, Wye Valley NHS Trust, Hereford, UK
| | - Shahab Hajibandeh
- Department of Hepatobiliary and Pancreatic Surgery, University Hospital of Wales, Cardiff, UK
| | - Komal Bodkhe
- Department of Infectious Disease, Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ghulam Nawaz
- Department of General Surgery, Hereford County Hospital, Wye Valley NHS Trust, Hereford, UK
| | - Nadeem Faridi
- Department of General Surgery, Hereford County Hospital, Wye Valley NHS Trust, Hereford, UK
| | - Dinez Peixoto
- Department of General Surgery, Hereford County Hospital, Wye Valley NHS Trust, Hereford, UK
| | - Irfan Kar
- Department of General Surgery, Hereford County Hospital, Wye Valley NHS Trust, Hereford, UK
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Schlosser KA, Warren JA. Hernia Mesh Complications: Management of Mesh Infections and Enteroprosthetic Fistula. Surg Clin North Am 2023; 103:1029-1042. [PMID: 37709388 DOI: 10.1016/j.suc.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
The potential consequences of mesh infection mandate careful consideration of surgical approach, mesh selection, and preoperative patient optimization when planning for ventral hernia repair. Intraperitoneal mesh, microporous or laminar mesh, and multifilament mesh typically require explantation, whereas macroporous, monofilament mesh in an extraperitoneal position is often salvageable. Delayed presentation of mesh infection should raise the suspicion for enteroprosthetic fistula when intraperitoneal mesh is present. When mesh excision is necessary, the surgeon must carefully consider both the risk of recurrent infection as well as hernia recurrence when deciding on single-stage definitive reconstruction versus primary closure with delayed reconstruction.
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Affiliation(s)
- Kathryn A Schlosser
- Department of Surgery, Prisma Health, 701 Grove Road, Support Tower 3, Greenville, SC 29605, USA. https://twitter.com/KT_Schlosser
| | - Jeremy A Warren
- Department of Surgery, Division of Minimal Access Surgery, University of South Carolina School of Medicine Greenville, Prisma Health, 701 Grove Road, Support Tower 3, Greenville, SC 29605, USA.
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Bueno-Lledó J, Martinez-Hoed J, Bonafe-Diana S, Pous-Serrano S. Mesh Infection After Hernia Repair and Negative Pressure Wound Therapy. A Systematic Review. World J Surg 2023; 47:1495-1502. [PMID: 36802233 DOI: 10.1007/s00268-023-06943-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Surgical mesh infection (SMI) after abdominal wall hernia repair (AWHR) is a challenging and highly debated clinical problem with no current consensus. The purpose of this review was to analyze the literature about the use of negative pressure wound therapy (NPWT) in the management of the conservative treatment of SMI and report results about infected mesh salvage. METHODS A systematic review of EMBASE and PUBMED was performed describing the use of NPWT in patients with SMI following AWHR. Reviewed articles evaluating data about the association between clinical, demographic, analytic and surgical characteristics about SMI after AWHR were analyzed. The high heterogeneity of these studies did not allow a meta-analysis of outcomes. RESULTS The search strategy yielded 33 studies from PubMed, and 16 studies from EMBASE. NPWT was performed in 230 patients across 9 studies being achieved the mesh salvage in 196 (85.2%). Of these 230 cases, 46% were polypropylene (PPL), 9.9% polyester (PE), 16.8% polytetrafluoroethylene (PTFE), 4% biologic and 10.2% composite mesh (PPL and PTFE). Infected mesh location was onlay (43%), retromuscular (22%), preperitoneal (19%), intraperitoneal (10%) and between the oblique muscles (5%). The better option on salvageability with the use of NPWT was the combination of macroporous PPL mesh in an extraperitoneal position (19.2% onlay, 23.3% preperitoneal, 48.8% retromuscular). CONCLUSION NPWT is a sufficient approach to treat SMI following AWHR. In most cases, infected prostheses can be salvaged with this management. Further studies with a larger sample size are needed to confirm our analysis results.
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Affiliation(s)
- Jose Bueno-Lledó
- Unit of Abdominal Wall Surgery. Department of Digestive Surgery, La Fe" Hospital University of Valencia, Calle Gabriel Miró 28, Puerta 12, 46008, Valencia, Spain.
| | | | - Santiago Bonafe-Diana
- Unit of Abdominal Wall Surgery. Department of Digestive Surgery, La Fe" Hospital University of Valencia, Calle Gabriel Miró 28, Puerta 12, 46008, Valencia, Spain
| | - Salvador Pous-Serrano
- Unit of Abdominal Wall Surgery. Department of Digestive Surgery, La Fe" Hospital University of Valencia, Calle Gabriel Miró 28, Puerta 12, 46008, Valencia, Spain
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What is the outcome of late-onset infected mesh removal after open tension-free inguinal hernioplasty: 3-year follow-up. Hernia 2022:10.1007/s10029-022-02684-w. [PMID: 36153372 DOI: 10.1007/s10029-022-02684-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 09/08/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE Reports of mesh infections following open tension-free inguinal hernioplasty are gradually increasing. Recent research has focused on identifying and managing mesh infections. However, studies examining the long-term outcomes and quality of life following mesh removal for late-onset infections are few. This study aimed to analyze the short and long-term outcomes after maximal removal of the implanted mesh in patients with late-onset mesh infection after open tension-free inguinal hernioplasty. METHODS Data of 105 patients who developed late-onset mesh infection after open tension-free inguinal hernioplasty and were admitted to our hospital from January 2014 to January 2019 were retrospectively analyzed. Patients were followed up by telephone or outpatient consultation for 3 years, focusing on hernia recurrence and mesh infection recurrence. Quality of life was assessed preoperatively and postoperatively using our developed scale; postoperative inguinal area pain was assessed using the visual analog score, and postoperative anxiety was assessed using the anxiety self-assessment scale. RESULTS Of the 105 patients who experienced late-onset mesh infection following open inguinal hernioplasty, 100 underwent mesh plug repair. The mean follow-up time was 58 months, and 10.5% (95/105) of the patients were lost to follow-up. Recurrence of infection was observed in 28.6% of patients (2/7) who underwent partial mesh removal and in 3.4% of patients (3/88) who underwent complete mesh removal. One inguinal hernia recurred 12 months after mesh removal (1.0% recurrence rate). In the third year following surgery as compared to the preoperative period, there were significant improvements in quality of life. CONCLUSIONS Hernia plugs may not be a good choice in tension-free inguinal hernia repair in view of the risk of late infections and fistulas. Remove all mesh at the time of the first operation for mesh infection. Hernia recurrence after late-onset infected mesh removal following open inguinal tension-free hernioplasty is rare. The post-operative quality of life, pain, and anxiety are gradually steadily improving.
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Li J, Wang Y, Shao X, Cheng T. The salvage of mesh infection after hernia repair with the use of negative pressure wound therapy (
NPWT
), a systematic review. ANZ J Surg 2022; 92:2448-2456. [DOI: 10.1111/ans.18040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 08/26/2022] [Accepted: 08/27/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Junsheng Li
- Department of General Surgery, Affiliated Zhongda Hospital Southeast University Nanjing China
| | - Yong Wang
- Department of Gastrointestinal Surgery, West China Hospital Sichuan University Chengdu China
| | - Xiangyu Shao
- Department of General Surgery, Affiliated Zhongda Hospital Southeast University Nanjing China
| | - Tao Cheng
- Department of General Surgery, Affiliated Zhongda Hospital Southeast University Nanjing China
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Bueno-Lledó J, Martínez-Hoed J, Pous-Serrano S. Negative pressure therapy in abdominal wall surgery. Cir Esp 2022; 100:464-471. [PMID: 35584763 DOI: 10.1016/j.cireng.2022.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 12/14/2021] [Indexed: 06/15/2023]
Abstract
Negative pressure wound therapy (NPWT) is widely known in surgical practice. The initial indications for NPWT were chronic wounds, especially diabetic foot, vascular and decubitus ulcers, and infected traumatic wounds. Nowadays, the use has been widely increased. Although in the field of abdominal wall surgery, it has mainly been used in the treatment of surgical wound complications after hernia repair, other indications have been added after years of experience in the management of NPWT. Therefore, the aim of this article is to analyze and review the main indications of NPWT in abdominal wall surgery, as well as the advantages obtained with its application.
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Affiliation(s)
- José Bueno-Lledó
- Unidad de Cirugía de Pared Abdominal, Hospital Universitari i Politècnic La Fe, Universidad de Valencia, Valencia, Spain.
| | | | - Salvador Pous-Serrano
- Unidad de Cirugía de Pared Abdominal, Hospital Universitari i Politècnic La Fe, Universidad de Valencia, Valencia, Spain
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In Vitro Cytotoxicity, Colonisation by Fibroblasts and Antimicrobial Properties of Surgical Meshes Coated with Bacterial Cellulose. Int J Mol Sci 2022; 23:ijms23094835. [PMID: 35563224 PMCID: PMC9105287 DOI: 10.3390/ijms23094835] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/22/2022] [Accepted: 04/25/2022] [Indexed: 02/04/2023] Open
Abstract
Hernia repairs are the most common abdominal wall elective procedures performed by general surgeons. Hernia-related postoperative infective complications occur with 10% frequency. To counteract the risk of infection emergence, the development of effective, biocompatible and antimicrobial mesh adjuvants is required. Therefore, the aim of our in vitro investigation was to evaluate the suitability of bacterial cellulose (BC) polymer coupled with gentamicin (GM) antibiotic as an absorbent layer of surgical mesh. Our research included the assessment of GM-BC-modified meshes’ cytotoxicity against fibroblasts ATCC CCL-1 and a 60-day duration cell colonisation measurement. The obtained results showed no cytotoxic effect of modified meshes. The quantified fibroblast cells levels resembled a bimodal distribution depending on the time of culturing and the type of mesh applied. The measured GM minimal inhibitory concentration was 0.47 µg/mL. Results obtained in the modified disc-diffusion method showed that GM-BC-modified meshes inhibited bacterial growth more effectively than non-coated meshes. The results of our study indicate that BC-modified hernia meshes, fortified with appropriate antimicrobial, may be applied as effective implants in hernia surgery, preventing risk of infection occurrence and providing a high level of biocompatibility with regard to fibroblast cells.
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11
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Gachabayov M, Latifi R. Different etiopathogeneses in early-onset and late-onset inguinal hernia mesh infections in a prospectively evaluated cohort. Acta Chir Belg 2021; 121:164-169. [PMID: 31690215 DOI: 10.1080/00015458.2019.1689648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Inguinal hernia mesh infection (IHMI) is a rare but a significant problem. The aim of this study was to determine whether etiopathogeneses of early-onset and late-onset IHMIs differ in terms of the origin of infectious agents, and route of dissemination. PATIENTS AND METHODS This was a retrospective cohort study with prospective data collection of patients operated on from 2013 to 2015. Early-onset IHMI was defined as symptoms developed within one year after the index surgery, whereas late-onset IHMI was defined as infection developed later than a year after the index surgery. Age, gender, ASA score, BMI, time from index surgery, isolated infectious agents and possible pathogeneses were analyzed. RESULTS During the study period, 1438 patients underwent inguinal hernia repair. Sixteen patients (1.1%) had IHMI, of whom nine were early-onset and seven late-onset. The groups were comparable for age (p = .54), gender (p = 1.0), BMI (p = .79), and ASA score (p = 1.0). The most common infectious agent in early-onset IHMI was St. aureus, whereas Enterococci and Enterobacter prevailed in late-onset IHMI. The possible pathogenesis of IHMI in seven patients with early-onset IHMI was primary exogenous infection, whereas in patients with late-onset IHMI the pathogenesis might be hematogenous or contact spread. All patients with IHMI underwent mesh removal. In two patients (one from each group), partial mesh removal was performed previously and IHMI recurred. CONCLUSIONS Early-onset hernia mesh infection is mostly caused by St. aureus through exogenous contamination, whereas its late-onset counterpart might be a result of hematogenous or contact spread of intestinal flora.
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Affiliation(s)
- Mahir Gachabayov
- Westchester Medical Center, New York Medical College, Valhalla, NY, USA
- Vladimir City Clinical Hospital of Emergency Medicine, Vladimir, Russia
| | - Rifat Latifi
- Westchester Medical Center, New York Medical College, Valhalla, NY, USA
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Zanatta M, Brancato G, Basile G, Basile F, Donati M. Abdominal wall mesh infection: a diagnostic and therapeutic flowchart proposal. Eur Surg 2021. [DOI: 10.1007/s10353-021-00705-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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13
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Hagiwara K, Hayashi S, Suzuki T, Song K, Takayama T. Urinary bladder fistula following laparoscopic inguinal hernioplasty: a case report. BMC Surg 2021; 21:183. [PMID: 33827542 PMCID: PMC8028706 DOI: 10.1186/s12893-021-01183-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 03/28/2021] [Indexed: 12/02/2022] Open
Abstract
Background Fistula formation due to mesh erosion into hollow viscera, such as the urinary bladder, is uncommon. To date, there have been no reports of fistula formation into the urinary bladder without evidence of mesh erosion after hernioplasty; herein, we report one such rare case, in which the clinical symptoms improved without any surgical intervention. Case presentation A 73-year-old man underwent a trans-abdominal preperitoneal repair for bilateral direct inguinal hernia. One month later, the patient experienced a painful induration in the right inguinal region, and computed tomography revealed fluid collection in this region. A culture of the aspirated fluid yielded no bacteria. Seven months later, he experienced another episode of painful induration in the same region. However, blood examination revealed a normal white blood cell count and C-reactive protein level. Moreover, no organisms were detected by aspirated fluid culture. Although the painful induration subsided after aspiration of the fluid collection, he developed gross hematuria and dysuria a month later. Cystoscopy revealed a fistula in the right wall of the urinary bladder that discharged a purulent fluid. Culture of the fluid revealed no bacteria, and there was no evidence of mesh erosion. Hematuria improved without therapeutic or surgical intervention. The patient’s clinical symptoms improved without mesh removal. Moreover, cystoscopy revealed that the fistula was scarred 12 months after the initial appearance of urinary symptoms. No further complications were observed during a 42-month follow-up period. Conclusions We report a rare case of a fistula in the urinary bladder without evidence of mesh erosion after laparoscopic hernioplasty. The patient’s condition improved without mesh removal. Fluid collection due to foreign body reaction to meshes can cause fistula formation in the urinary bladder without direct mesh contact.
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Affiliation(s)
- Ken Hagiwara
- Department of Digestive Surgery, Nihon University School of Medicine, 1-6 Kandasurugadai, Chiyoda-ku, Tokyo, 101-8309, Japan.
| | - Shigeoki Hayashi
- Department of Digestive Surgery, Nihon University School of Medicine, 1-6 Kandasurugadai, Chiyoda-ku, Tokyo, 101-8309, Japan
| | - Takeki Suzuki
- Department of Surgery, Toride Medical Association Hospital, Ibaraki, Japan
| | - Keio Song
- Department of Digestive Surgery, Nihon University School of Medicine, 1-6 Kandasurugadai, Chiyoda-ku, Tokyo, 101-8309, Japan
| | - Tadatoshi Takayama
- Department of Digestive Surgery, Nihon University School of Medicine, 1-6 Kandasurugadai, Chiyoda-ku, Tokyo, 101-8309, Japan
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Tomaoglu K, Okmen H. Prosthetic mesh hernioplasty versus primary repair in incarcerated and strangulated groin and abdominal wall hernias with or without organ resection. Retrospective study. Langenbecks Arch Surg 2021; 406:1651-1657. [PMID: 33733286 DOI: 10.1007/s00423-021-02145-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 03/03/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The use of synthetic materials in emergency surgery for abdominal wall hernia in a potentially infected operating field has long been debated. In the present study, we evaluated the outcome of mesh prostheses in the management of incarcerated and strangulated abdominal wall hernias with or without organ resection. METHODS Between March 2012 and January 2020, medical records of 301 patients who underwent emergency surgery for incarcerated and strangulated abdominal wall hernias were retrospectively evaluated. The interventions were exclusively realized by two surgical teams, one of which used polypropylene mesh prostheses (group I), whereas the second team performed primary hernia repair (group II). The outcome of patients was observed for a mean follow-up period of 18.2 months. Categorical data were analyzed with the χ2 test or likelihood ratio. Logistic regression was used for adjustments in multivariate analysis. Statistical analyses were realized with SPSS, version 18. P values < 0.05 were considered statistically significant. For multiple comparisons between types of hernia, the significance level was set to P < 0.0083 according to Bonferroni adjustment. RESULTS Of the 301 patients, 190 were men (63.1%), and 111 were women (36.9%). The mean age was 59,98 years (range 17-92). Overall, 226 (75.1%) patients were treated with synthetic mesh replacement. One hundred two organ resections (34%) were performed involving the omentum, small intestine, colon, and appendix. No significant difference was identified in terms of postoperative complications, between the two groups both in patients who underwent organ resection and in patients who did not. CONCLUSION Synthetic materials may safely be used in the emergency management of incarcerated and strangulated groin and abdominal wall hernias in patients with or without organ resection, although they cannot formally be recommended due to the limited number of cases of the present study.
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Affiliation(s)
- Kamer Tomaoglu
- Faculty of Health Sciences, Department of General Surgery, School of Medical Sciences, Esenyurt University, Istanbul, Turkey.
| | - Hasan Okmen
- Department of General Surgery, Istanbul Training and Research Hospital, Istanbul, Turkey
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The negative pressure wound therapy may salvage the infected mesh following open incisional hernia repair. Ann Med Surg (Lond) 2020; 61:64-68. [PMID: 33408855 PMCID: PMC7773670 DOI: 10.1016/j.amsu.2020.12.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 12/11/2020] [Accepted: 12/11/2020] [Indexed: 11/26/2022] Open
Abstract
Background s: Incisional hernias may occur in 10–25% of patients undergoing laparotomy. In cases of a surgical site infection (SSI) after incisional hernia repair (IHR) secondary operative intervention with mesh removal are often needed. There is only minimal data available in the literature regarding the treatment of a wound infection with negative pressure wound therapy (NPWT). Conducting the study at hand, we aimed to provide more evidence on this topic. Methods From April to June 2020 a monocentric retrospective study has been performed. Patients who underwent NPWT due to a SSI with mesh involvement following open IHR from 2007 to 2020 were included. The primary endpoint was the mesh removal rate in the end of NPWT. Main secondary endpoints were the duration of NPWT and the amount of NPWT procedures. Results The data of 30 patients were extracted. The average age was 65.9 years (9.9). A total of 13 individuals were male and 17 females. The BMI was on average 31.1 kg/m2 (4.9). All patients received a polypropylene mesh. The average duration of NPWT was 31.3 days (22.1). The first wound revision with initiation of a NPWT was conducted on average 31.1 days (34.0) after IHR. The average amount of NPWT procedures was 8.3 (7.2). In 5 of 30 patients (16.6%) the mesh was removed (Open sublay group n = 4 (36.34%) vs. open onlay group n = 1 (5.26%), p = 0.047). Conclusion In cases of SSI following IHR the NPWT may facilitate mesh selvage. Further trials with a larger sample size are mandatory to confirm our hypothesis. As one of a main complication SSI may occur in up to 30% of cases following incisional hernia repair. The mesh is often removed in cases of a SSI. NPWT may salvage mesh removal in cases of mesh infection.
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Whitehead-Clarke T, Windsor A. Surgical Site Infection: The Scourge of Abdominal Wall Reconstruction. Surg Infect (Larchmt) 2020; 22:357-362. [PMID: 33021436 DOI: 10.1089/sur.2020.325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background: Surgical site infection (SSI) is a well-recognized and potentially catastrophic complication of abdominal wall reconstruction (AWR). The authors present a review of the literature surrounding SSI in AWR, exploring prevention and treatment strategies as well as risk factors. Methods: A comprehensive review of the current literature was undertaken. Evidence was reviewed and summarized with particular focus on prevention and treatment strategies available to hernia surgeons. Results: Patient risk factors for SSI are well described in the literature and include obesity, smoking, and other comorbidities. Contaminated hernias and cases involving enterocutaneous fistulae are also at higher risk of SSI. Surgical decisions such as type of mesh, plane of mesh placement, and fascial release may all contribute to SSI risk. To treat established mesh infection, conservative management with antibiotic agents and negative pressure therapy is a reasonable option in some cases. Removal of prosthesis appears to provide favorable results, however, repeat surgery can be problematic Conclusions: Surgical site infection remains an important pathology in the world of AWR. Surgeons have a wealth of tools in their arsenal to prevent and treat SSI and should be aware of the emerging evidence in the fast-moving specialty of hernia surgery. Complex cases should be handled by surgeons and centers with expertise in treating such patients.
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Biosynthetic Resorbable Prosthesis is Useful in Single-Stage Management of Chronic Mesh Infection After Abdominal Wall Hernia Repair. World J Surg 2020; 45:443-450. [PMID: 33025154 DOI: 10.1007/s00268-020-05808-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The goal of this article was to report the results about the efficacy of treatment of chronic mesh infection (CMI) after abdominal wall hernia repair (AWHR) in one-stage management, with complete mesh explantation of infected prosthesis and simultaneous reinforcement with a biosynthetic poly-4-hydroxybutyrate absorbable (P4HB) mesh. METHODS This is a retrospective analysis of all patients that needed mesh removal for CMI between September 2016 and January 2019 at a tertiary center. Epidemiological data, hernia characteristics, surgical, and postoperative variables (Clavien-Dindo classification) of these patients were analyzed. RESULTS Of the 32 patients who required mesh explantation, 30 received one-stage management of CMI. In 60% of the patients, abdominal wall reconstruction was necessary after the infected mesh removal: 8 cases (26.6%) were treated with Rives-Stoppa repair, 4 (13.3%) with a fascial plication, 1 (3.3%) with anterior component separation, and 1 (3.3%) with transversus abdominis release to repair hernia defects. Three Lichtenstein (10%) and 1 Nyhus repairs (3.3%) were performed in patients with groin hernias. The most frequent postoperative complications were surgical site occurrences: seroma in 5 (20%) patients, hematoma in 2 (6.6%) patients, and wound infection in 1 (3.3%) patient. During the mean follow-up of 34.5 months (range 23-46 months), the overall recurrence rate was 3.3%. Persistent, recurrent, or new CMIs were not observed. CONCLUSIONS In our experience, single-stage management of CMI with complete removal of infected prosthesis and replacement with a P4HB mesh is feasible with acceptable results in terms of mesh reinfection and hernia recurrence.
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Bueno-Lledó J, Ceno M, Pérez-Alonso C, Martinez-Hoed J, Pous-Serrano S. Abdominal wall reconstruction with biosynthetic absorbable mesh after infected prosthesis explantation: single stage is better than two-stage approach of chronic mesh infection. Hernia 2020; 25:1005-1012. [PMID: 33001317 DOI: 10.1007/s10029-020-02309-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 09/16/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To assess the efficacy of surgical management of chronic mesh infection (CMI) after abdominal wall hernia repair (AWHR) in single-stage approach (complete removal of infected prosthesis and simultaneous replacement with poly-4-hydroxybutyrate mesh or BAM group), comparing results with two-stage treatment (complete mesh excision and abdominal wall repair with synthetic mesh after several months or SPM group). METHODS Retrospective comparative study of all patients who underwent surgery for CMI between January 2006 and January 2019 at a tertiary center. We compared results in terms of epidemiological data, hernia and prosthesis characteristics, surgical and postoperative variables of both two groups. RESULTS Over the 13-year study period, 2791 AWHR was performed at our hospital; the overall CMI rate was 2.5%. Of 71 patients, 30 (42.2%) were in BAM group and 41 (57.8%) in SPM group. The median cumulative operative time (252 min versus 132 min) and length of stay (16.6 days versus 6.2 days) were significatively longer in SPM group compared with BAM group, due to the need of two surgical procedures. There were a higher number of postoperative complications in SPM group (p = 0.002), some of them grade III. With mean follow-up of 36.5 months (range 21-59), there were no significant differences in terms of overall hernia recurrence and mesh reinfection in both groups. CONCLUSION The use of a poly-4-hydroxybutyrate resorbable mesh in single-stage management of CMI may be a safe and better option than two-stage approach, although more studies are needed to confirm our results.
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Affiliation(s)
- J Bueno-Lledó
- Unit of Abdominal Wall Surgery, Department of Digestive Surgery, Hospital Universitari i Politecnic "La Fe", University of Valencia, Calle Gabriel Miró 28, puerta 12, 46008, Valencia, Spain.
| | - M Ceno
- Klinikum Mittelbaden, Balger Strasse 50, 76530, Baden-Baden, Germany
| | - C Pérez-Alonso
- Unit of Abdominal Wall Surgery, Department of Digestive Surgery, Hospital Universitari i Politecnic "La Fe", University of Valencia, Calle Gabriel Miró 28, puerta 12, 46008, Valencia, Spain
| | - J Martinez-Hoed
- Unit of Abdominal Wall Surgery, Department of Digestive Surgery, Hospital Universitari i Politecnic "La Fe", University of Valencia, Calle Gabriel Miró 28, puerta 12, 46008, Valencia, Spain
| | - S Pous-Serrano
- Unit of Abdominal Wall Surgery, Department of Digestive Surgery, Hospital Universitari i Politecnic "La Fe", University of Valencia, Calle Gabriel Miró 28, puerta 12, 46008, Valencia, Spain
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Re-do surgery after prosthetic abdominal wall repair: intraoperative findings of mesh-related complications. Hernia 2020; 25:435-440. [PMID: 32495044 DOI: 10.1007/s10029-020-02225-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 05/20/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Mesh repair is one of the most popular technique for the treatment of abdominal wall hernias, resulting in lower recurrence rates. However, it is associated with a high risk of mesh-related complications. The aim of the present study is to assess the impact of biomaterials on the intra-abdominal organs, in terms of adhesions and visceral complications, in a series of patients undergoing re-do surgery at our abdominal wall unit. MATERIALS AND METHODS We reviewed the clinical records of 301 patients who undergone laparotomy between June 2008 and May 2018, selecting 67 patients with one or more previous prosthetic abdominal wall repair (AWR). RESULTS The average number of previous repairs was 1.6 with a mean time interval of 66 months from the last repair. Clinical presentation included hernia recurrence (69%), mesh infection (26%), infection and recurrence (10%), and fistula (1%). Adhesions were intraoperatively observed in all patients, except for eight cases. Mesh was completely removed in 43 patients, partially in four. Postoperative complications were observed in 39% of cases, including wound dehiscence, hematoma, seroma, and mesh infection. CONCLUSIONS Long-term implant results in abdominal wall repair and are not completely known, and literature is still lacking on this topic. Re-do surgery for subsequent pathological events may represent a way to increase our knowledge.
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Yang X, Aihemaiti M, Zhang H, Jiang L, Zhang G, Qin M, Pan Y, Wen X, Chan FSY, Fan JKM. Mesh-preservation approach to treatment of mesh infection after large incisional ventral hernia repair-how I do it. ANNALS OF TRANSLATIONAL MEDICINE 2020; 7:698. [PMID: 31930099 DOI: 10.21037/atm.2019.10.82] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Mesh infection after large incisional ventral hernia repair is a clinical dilemma in abdominal wall hernia surgery. It is believed foreign material should be removed but it causes secondary trauma to the abdominal wall tissue and might be associated with a higher risk of complications. Currently, there is no consensus on mesh-preservation treatment in cases of mesh infection after hernia repair in general. Herein we present the case of a 27-year-old male who recovered well from mesh infection after large incisional ventral hernia repair by mesh-preservation approach. The path to success is choice of material of prosthetic mesh; surgical approach of hernia repair, sufficient wound irrigation and drainage, and acquiring sterility of the mesh surface by wound care techniques such as local iodophor packing and vacuum sealing drainage. Clinical cohorts are needed to verify the feasibility of mesh-preservation treatment of mesh infection after large incisional hernia repair.
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Affiliation(s)
- Xuefei Yang
- Department of Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, China
| | - Maimaiti Aihemaiti
- Department of Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, China
| | - Hao Zhang
- Department of Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, China
| | - Li Jiang
- Department of Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, China
| | - Guixi Zhang
- Department of Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, China
| | - Mali Qin
- Department of Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, China
| | - Yiheng Pan
- Department of Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, China
| | - Xiumei Wen
- Department of Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, China
| | - Fion Siu Yin Chan
- Department of Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, China.,Department of Surgery, The University of Hong Kong, Hong Kong, China
| | - Joe King Man Fan
- Department of Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, China.,Department of Surgery, The University of Hong Kong, Hong Kong, China
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21
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Mesh fistula after ventral hernia repair: What is the optimal management? Surgery 2019; 167:590-597. [PMID: 31883631 DOI: 10.1016/j.surg.2019.09.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 09/03/2019] [Accepted: 09/23/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND A mesh-related intestinal fistula is an uncommon and challenging complication of ventral hernia repair. Optimal management is unclear owing to lack of prospective or long-term data. METHODS We reviewed our prospective data for mesh-related intestinal fistulas from 2004 to 2017and compared suture repair versus ventral hernia repair with mesh at the time of mesh-related intestinal fistula takedown. RESULTS Eighty-two mesh-related intestinal fistulas were treated; none of the fistulas had closed spontaneously, and all fistula persisted at the time of our treatment. Mean age was 61 ± 12 years with 33-month follow-up. Comorbidities were similar between groups. Defects were 2.5-times larger in ventral hernia repair with mesh (324 ± 392 cm2 vs 1301 ± 133 cm2; P = .044). Components separation (64% vs 21%; P = .0003) and panniculectomy (35% vs 7%; P = .0074) were more common in ventral hernia repair with mesh. Mortality occurred in 4 patients. Complications were similar. In patients undergoing ventral hernia repair with non-bridged, acellular, porcine dermal matrix, hernia recurrence was less than in patients without mesh (26% vs 66%; P = .0030). Only partial excision of the mesh involved with the fistula resulted in a substantial increase in developing another fistula (29% vs 6%; P < .05). CONCLUSION Patients undergoing preperitoneal ventral hernia repair with mesh for mesh-related intestinal fistula had a lesser rate of hernia recurrence and similar complications compared to suture repair despite larger hernias. Complete mesh excision decreases the risk of fistula recurrence. We maintain that ventral hernia repair with mesh during mesh-related intestinal fistula takedown represents the best opportunity for a durable herniorrhaphy.
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Plymale MA, Davenport DL, Walsh-Blackmore S, Hess J, Griffiths WS, Plymale MC, Totten CF, Roth JS. Costs and Complications Associated with Infected Mesh for Ventral Hernia Repair. Surg Infect (Larchmt) 2019; 21:344-349. [PMID: 31816266 DOI: 10.1089/sur.2019.183] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background: Mesh hernia repair is widely accepted because of the associated reduction in hernia recurrence compared with suture-based repair. Despite initiatives to reduce risk, mesh infection and mesh removal are a significant challenge. In an era of healthcare value, it is essential to understand the global cost of care, including the incidence and cost of complications. The purpose of this study was to identify the outcomes and costs of care of patients who required the removal of infected hernia mesh. Methods: A review of databases from 2006 through June 2018 identified patients who underwent both ventral hernia repair (VHR) and re-operation for infected mesh removal. Patient demographic and operative details for both procedures, including age, Body Mass Index, mesh type, amount of time between procedures, and information regarding interval procedures were obtained. Clinical outcome measures were the length of the hospital stay, hospital re-admission, incision/non-incision complications, and re-operation. Hospital cost data were obtained from the cost accounting system and were combined with the clinical data for a cost and clinical representation of the cases. Results: Thirty-four patients underwent both VHR and removal of infected mesh material over the 12-year time frame and were included in the analyses; the average age at VHR was 48 years, and 16 patients (47%) were female. Following VHR, 21 patients (62%) experienced incision complications within 90 days post-operatively, the complications ranging from superficial surgical site infection (SSI) to evisceration. A mean of 22.65 months passed between procedures. After mesh removal, 16 patients (47%) experienced further incisional complications; and 22 (65%) patients had at least one re-admission. Eighteen patients (53%) required a minimum of one additional related operative procedure after mesh removal. Median hospital costs nearly doubled (p < 0.001) for the mesh removal ($23,841 [interquartile range {IQR} $13,596-$42,148]) compared with the VHR admission ($13,394 [IQR $8,424-$22,161]) not accounting for re-admission costs. A majority experienced hernia recurrence subsequent to mesh removal. Conclusions: Mesh infection after hernia repair is associated with significant morbidity and costs. Hospital re-admission, re-operations, and recurrences are common among these patients, resulting in greater healthcare resource utilization. Development of strategies to prevent mesh infection, identify patients most likely to experience infectious complications, and define best practices for the care of patients with mesh infection are needed.
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Affiliation(s)
- Margaret A Plymale
- Division of General Surgery, University of Kentucky, Lexington, Kentucky, USA
| | | | | | - Jordan Hess
- College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | | | - Mary C Plymale
- Division of General Surgery, University of Kentucky, Lexington, Kentucky, USA
| | - Crystal F Totten
- Division of General Surgery, University of Kentucky, Lexington, Kentucky, USA
| | - John Scott Roth
- Division of General Surgery, University of Kentucky, Lexington, Kentucky, USA
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Recurrence of infection and hernia following partial versus complete removal of infected hernia mesh: a systematic review and cohort meta-analysis. Hernia 2019; 24:433-439. [DOI: 10.1007/s10029-019-02095-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 11/17/2019] [Indexed: 11/30/2022]
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The influence of mesh removal during laparoscopic repair of recurrent ventral hernias on the long-term outcome. Wideochir Inne Tech Maloinwazyjne 2019; 14:366-373. [PMID: 31534565 PMCID: PMC6748057 DOI: 10.5114/wiitm.2019.85350] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 05/06/2019] [Indexed: 01/29/2023] Open
Abstract
Introduction Recurrent hernias can be treated by laparoscopy without the need for mesh removal. However, shrinkage of the mesh following recurrence affects most of the patients, and leaving a partially floating and rigid foreign body could be discussed. Aim To compare the outcomes of patients regarding the removal of previous mesh during laparoscopic repair of recurrent abdominal wall hernias. Material and methods Patients who underwent laparoscopic repair for recurrent ventral hernias between August 2012 and March 2015 were included in the study. The patients with complete removal of the mesh were included in the MR group and the patients with partial removal or without removal of the previous mesh were included in the non-MR group. Patient characteristics and demographics, previous hernia repair, defect size, mesh size, operative time, mean hospital stay, complications, recurrences, numeric pain rating scale (NRS), early termination of analgesics and prolonged use of analgesics were compared. Results A total of 112 patients with a mean age of 53.2 and mean body mass index of 31.1 kg/m2 underwent laparoscopic repair. There were 47 patients in the MR group and 54 patients in the non-MR group. Operative time was shorter in the non-MR group (p < 0.05), whereas symptomatic seroma and NRS scores on postoperative day 10 and at the 6th week were higher in comparison with the MR group (p < 0.05). Conclusions Mesh removal during laparoscopic repair of recurrent ventral hernias has an association with the reduction of pain and symptomatic seroma. However, further prospective comparative studies are required to verify this view.
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Filipović-Čugura J, Misir Z, Hrabač P, Orešić T, Vidović D, Misir B, Filipović N, Kirac I, Mijić A. Comparison of Surgisis, Vypro II and TiMesh in contaminated and clean field. Hernia 2019; 24:551-558. [PMID: 30976937 DOI: 10.1007/s10029-019-01949-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 04/01/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE The study aimed to evaluate the histologic properties and infection resistance of three different mesh materials in a rat model. METHODS Each mesh, in both infectious (n = 96) and non-infectious groups (n = 270), was positioned both in sublay (preperitoneally) and onlay (subcutaneously) locations. Properties of the biological (Surgisis; Cook Surgical), composite, partially resorbing (Vypro II mesh; Ethicon) and non-resorbing (TiMesh; GFE Medizintechnik GmbH) mesh were evaluated and compared. Animals were killed at 7, 21 and 90 days after implantation. The following parameters were evaluated to assess the host response to the mesh material: inflammation, vascularization, fibrosis, collagen formation, Ki67, and a foreign body reaction by granuloma formation (FBG). RESULTS Surgisis mesh produced more pronounced inflammation and cell proliferation, and less intense granuloma formation, as well as fibrosis, compared to the other two groups. When the infected materials were examined, we found signs of local infection to be more often present in Surgisis group of animals. CONCLUSIONS In the presence of bacterial contamination, no benefits were observed in the use of the Surgisis prosthesis over the use of TiMesh and Vypro II.
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Affiliation(s)
- J Filipović-Čugura
- Department of Surgery, Sestre Milosrdnice University Hospital Center, Vinogradska cesta 29, 10000, Zagreb, Croatia
| | - Z Misir
- Department of Surgery, Sestre Milosrdnice University Hospital Center, Vinogradska cesta 29, 10000, Zagreb, Croatia
| | - P Hrabač
- Croatian Institute for Brain Research, University of Zagreb, School of Medicine, Šalata 3, 10000, Zagreb, Croatia
| | - T Orešić
- University Hospital for Tumors, Sestre Milosrdnice University Hospital Center, Ilica 197, 10000, Zagreb, Croatia
| | - D Vidović
- Department of Surgery, Sestre Milosrdnice University Hospital Center, Vinogradska cesta 29, 10000, Zagreb, Croatia
| | - B Misir
- Department of Surgery, Sestre Milosrdnice University Hospital Center, Vinogradska cesta 29, 10000, Zagreb, Croatia
| | - N Filipović
- University of Zagreb, School of Medicine, Šalata 3, 10000, Zagreb, Croatia
| | - I Kirac
- University Hospital for Tumors, Sestre Milosrdnice University Hospital Center, Ilica 197, 10000, Zagreb, Croatia.
| | - A Mijić
- Department of Surgery, Sestre Milosrdnice University Hospital Center, Vinogradska cesta 29, 10000, Zagreb, Croatia
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de Miguel I, Prieto I, Albornoz A, Sanz V, Weis C, Turon P, Quidant R. Plasmon-Based Biofilm Inhibition on Surgical Implants. NANO LETTERS 2019; 19:2524-2529. [PMID: 30860848 DOI: 10.1021/acs.nanolett.9b00187] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The insertion of an implant in the body of a patient raises the risk of a posterior infection and formation of a biofilm, which can have critical consequences on the patient's health and be associated with a high sanitary cost. While antibacterial agents can be used to prevent the infection, such a strategy is time-limited and causes bacteria resistance. As an alternative to biochemical approaches, we propose here to use light-induced local hyperthermia with plasmonic nanoparticles. This strategy is implemented on surgical meshes, extensively used in the context of hernia repairing, one of the most common general surgeries. Surgical meshes were homogeneously coated with gold nanorods designed to efficiently convert near-infrared light into heat. The modified mesh was exposed to a biofilm of Staphylococcus aureus ( S. aureus) bacteria before being treated with a train of light pulses. We systematically study how the illumination parameters, namely fluence, peak intensity and pulse length, influence the elimination of attached bacteria. Additionally, fluorescence confocal microscopy provides us some insight on the mechanism involved in the degradation of the biofilm. This proof-of-principle study opens a new set of opportunities for the development of novel disinfection approaches combining light and nanotechnology.
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Affiliation(s)
- Ignacio de Miguel
- ICFO-Institut de Ciències Fotòniques , The Barcelona Institute of Science and Tehcnology , 08860 Castelldefels (Barcelona) , Spain
| | - Irene Prieto
- Department of Research and Development , B. Braun Surgical, S.A. , 08191 Rubí, Barcelona , Spain
| | - Arantxa Albornoz
- ICFO-Institut de Ciències Fotòniques , The Barcelona Institute of Science and Tehcnology , 08860 Castelldefels (Barcelona) , Spain
| | - Vanesa Sanz
- Department of Research and Development , B. Braun Surgical, S.A. , 08191 Rubí, Barcelona , Spain
| | - Christine Weis
- Department of Research and Development , B. Braun Surgical, S.A. , 08191 Rubí, Barcelona , Spain
| | - Pau Turon
- Department of Research and Development , B. Braun Surgical, S.A. , 08191 Rubí, Barcelona , Spain
| | - Romain Quidant
- ICFO-Institut de Ciències Fotòniques , The Barcelona Institute of Science and Tehcnology , 08860 Castelldefels (Barcelona) , Spain
- ICREA -Institució Catalana de Recerca i Estudis Avançats , 08010 Barcelona , Spain
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Kao AM, Arnold MR, Otero J, Huang LC, Prasad T, Lincourt AE, Augenstein VA. Comparison of Outcomes After Partial Versus Complete Mesh Excision. Ann Surg 2019; 272:177-182. [PMID: 30672793 DOI: 10.1097/sla.0000000000003198] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Evaluate outcomes of patients undergoing mesh explantation following partial mesh excision (PME) and complete mesh excision (CME). BACKGROUND Ventral hernia repair (VHR) with mesh remains one of the most commonly performed procedures worldwide. Management of previously placed mesh during reexploration remains unclear. Studies describing PME as a feasible alternative have been limited. METHODS The AHSQC registry was queried for VHR patients who underwent mesh excision. Variables used for propensity-matching included age, BMI, race, diabetes, COPD, OR time>2 hours, immunosuppressants, smoking, active infection, ASA class, elective case, wound classification, and history of abdominal wall infection. RESULTS A total of 1904 VHR patients underwent excision of prior mesh. After propensity matching, complications were significantly higher (35% vs 29%, P = 0.01) after PME, including SSI/SSO, SSOPI, and reoperation. No differences were observed in patients with clean wounds, however in clean-contaminated, PME more frequently resulted in SSOPI (24% vs 9%, P = 0.02). In mesh infection/fistulas, higher rates of SSOPI (46% vs 24%, P = 0.04) and reoperation (21% vs 6%, P = 0.03) were seen after PME. Odds-ratio analysis showed increased likelihood of SSOPI (OR 1.5, 95% CI 1.05-2.14; P = 0.023) and reoperation (OR 2.2, 95% CI 1.13-4.10; P = 0.015) with PME. CONCLUSIONS With over 350,000 VHR performed annually and increasing mesh use, guidelines for management of mesh during reexploration are needed. This analysis of a multicenter hernia database demonstrates significantly increased postoperative complications in PME patients with clean-contaminated wounds and mesh infections/fistulas, however showed similar outcomes in those with clean wounds.
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Affiliation(s)
- Angela M Kao
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC
| | - Michael R Arnold
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC
| | - Javier Otero
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC
| | - Li-Ching Huang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Tanushree Prasad
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC
| | - Amy E Lincourt
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC
| | - Vedra A Augenstein
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC
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Ortega-Deballon P. Total or partial removal of infected mesh? Invited comment. Hernia 2018; 22:951-952. [PMID: 30406323 DOI: 10.1007/s10029-018-1842-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 10/26/2018] [Indexed: 11/24/2022]
Affiliation(s)
- P Ortega-Deballon
- Department of General and Digestive Surgery, University Hospital of Dijon, Dijon, France.
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Abstract
PURPOSE As more mesh is implanted for hernia repairs, mesh-related complications may increase, with some requiring mesh removal. We describe our experience as to indications and perioperative factors that surround hernia mesh removal. METHODS All patients who underwent hernia mesh removal from the abdomen (ventral, flank) and pelvis (inguinal, femoral, obturator, perineal) were captured from a single hernia center database. RESULTS Over 4.5 years, we removed 105 mesh. Most were in males (58%), average age 53 years, with average pain score 5/10. Males most commonly had mesh removed from the pelvis (65%), and females from the abdomen (63%, P = 0.009). Pain score was significantly higher prior to removal of hernia mesh from the pelvis (5.7 vs 4.5, P = 0.047). Type of mesh implanted and positioning of mesh showed no difference in pain (P > 0.05). Indications for hernia mesh removal significantly varied between the abdomen (infection, 43%) and the pelvis (pain, 91%, P < 0.0001). Mesh reaction became a more frequent indication for mesh removal in the pelvis, reaching 1/3 of patients by 2017. Most required general anesthesia (87%), with inpatient stay (53%, mode 1 day). Open technique decreased with time (82-17%), laparoscopic decreased (20-10%), and robotic increased (0-70%). CONCLUSIONS This is the largest and most comprehensive study detailing why we remove mesh. We provide awareness of indications and operative options to help guide physicians as they encounter patients who may require hernia mesh removal.
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Prevention and Treatment Strategies for Mesh Infection in Abdominal Wall Reconstruction. Plast Reconstr Surg 2018; 142:149S-155S. [DOI: 10.1097/prs.0000000000004871] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Comparison of complete versus partial mesh removal for the treatment of chronic mesh infection after abdominal wall hernia repair. Hernia 2018; 22:773-779. [DOI: 10.1007/s10029-018-1785-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 05/18/2018] [Indexed: 10/16/2022]
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