Conservative management of mesh-site infection in hernia repair.
BACKGROUND
Mesh hernioplasty is the preferred surgical procedure for large abdominal wall hernias. Infection remains one of the most challenging complications of this operation. Salvaging infected prosthetic material after ventral hernia repair is rarely successful. Most cases require mesh excision and complex abdominal wall reconstruction, with variable success rates. In this article, we report 3 cases of mesh salvage after laparoscopic ventral herniorrhapy with a novel use of percutaneous drainage and antibiotic irrigation.


RESULTS
Three patients developed infected seromas after laparoscopic ventral hernia repair. The fascial defect of the first patient was repaired with a commercially available 20 x 18 cm polytetrafluoroethylene (PTFE) mesh. A complex fluid collection developed the following month in the anterior abdominal wall overlying the patient's mesh. The cultures grew Staphylococcus aureus. The second patient had a 30 x 20 cm PTFE mesh placed, which developed a fluid collection with Enterococcus faecalis and Escherichia coli. The third case underwent repair, using a another commercially available 22 x 28 cm PTFE mesh. A fluid collection measuring 20 x 10 cm in the anterior abdominal wall developed, growing Staphylococcus lugdunensis. In all 3 cases, a percutaneous drain was placed within the fluid collection and long-term intravenous (i.v.) access was obtained. I.v. antibiotics were initiated. In addition, gentamicin (80 mg) with 20 mL of saline was infused through the drain 3 times a day. All patients have remained free of clinical signs of infection following the completion of therapy.


CONCLUSIONS
Infected mesh after laparoscopic ventral herniorrhapy without systemic sepsis may be amenable to nonoperative treatment. A conservative approach that includes percutaneous drainage followed by antibiotic irrigation is a potential alternative to prosthetic removal in carefully selected patients. Further evaluation of this technique is warranted to define the most appropriate management strategies for these patients.
Department of General Surgery, Mayo Clinic Hospital, Phoenix, Arizona 85054, USA. Aguilar.Brenda@mayo.edu
Brenda
B
Aguilar
Alyssa B
AB
Chapital
James A
JA
Madura
Kristi L
KL
Harold
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D013293:Enterococcus faecalis; D004927:Escherichia coli Infections / Q000628:therapy; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000628:therapy; D006555:Hernia, Ventral / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D049291:Seroma / Q000209:etiology / Q000628:therapy; D013203:Staphylococcal Infections / Q000628:therapy; D013526:Surgical Mesh; D013530:Surgical Wound Infection / Q000628:therapy*
D000900:Anti-Bacterial Agents; D011138:Polytetrafluoroethylene