title: Drainage of collections associated with hernia mesh: is it worthwhile?
abstract: OBJECTIVE
  Synthetic mesh has revolutionized abdominal wall hernia repair. However, mesh infections present a clinical problem because the standard practice of surgical excision is fraught with increased morbidity. Here, single-institutional outcomes in managing mesh-related collections via percutaneous drainage are retrospectively reviewed to assess its effectiveness.
  
  
  METHODS
  A total of 21 patients underwent drainage of perimesh collections. Three types of mesh were employed: polytetrafluoroethylene (PTFE; n = 5), polypropylene (n = 14), and porcine dermal collagen (n = 3). One patient received both polypropylene and PTFE. Drainage was performed with ultrasound guidance (n = 19) or surgical drain exchange (n = 2). Mesh type, culture results, fluid collection size, and location were analyzed with respect to need for mesh excision.
  
  
  RESULTS
  Sixteen of 21 patients (76%) were successfully treated with drainage. One required additional surgical capsulectomy; the mesh was salvaged. Four required mesh excision because of recurrent infection (n = 2) or lack of improvement of clinical course (n = 2). Recurrent infection occurred in six patients, with mesh salvage via conservative management or new drainage in four. Fluid cultures were positive in 68% of patients (n = 13), with Staphylococcus aureus the most common organism. Cultures did not predict mesh excision (P = .26). The PTFE excision rate trended higher compared with polypropylene (40% vs 14%; P = .27). No porcine dermal collagen mesh was excised. Neither fluid collection size nor location predicted mesh excision. Mean follow-up was 319 days (range, 6-1,406 d).
  
  
  CONCLUSIONS
  Percutaneous drainage of suspected mesh-related abscess is effective. The use of PTFE mesh trended toward a higher excision rate.
authors.affiliation: Division of Interventional Radiology, Department of Radiology, University of Pennsylvania Medical Center, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104, USA.
authors.forename: Yuo-Chen
authors.initials: YC
authors.lastname: Kuo
authors.forename: Jeffrey I
authors.initials: JI
authors.lastname: Mondschein
authors.forename: Michael C
authors.initials: MC
authors.lastname: Soulen
authors.forename: Aalpen A
authors.initials: AA
authors.lastname: Patel
authors.forename: Alexander
authors.initials: A
authors.lastname: Nemeth
authors.forename: S William
authors.initials: SW
authors.lastname: Stavropoulos
authors.forename: Peter D
authors.initials: PD
authors.lastname: Kelly
authors.forename: Maxim
authors.initials: M
authors.lastname: Itkin
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Solomon
authors.forename: Richard D
authors.initials: RD
authors.lastname: Shlansky-Goldberg
authors.forename: Scott O
authors.initials: SO
authors.lastname: Trerotola
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004322:Drainage / Q000379:methods*; D005260:Female; D006547:Hernia / Q000150:complications / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control*; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control*; D013526:Surgical Mesh / Q000009:adverse effects*; D016896:Treatment Outcome