Drainage of collections associated with hernia mesh: is it worthwhile?
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.
Kuo
Yuo-Chen
YC
Division of Interventional Radiology, Department of Radiology, University of Pennsylvania Medical Center, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104, USA.
Mondschein
Jeffrey I
JI
Soulen
Michael C
MC
Patel
Aalpen A
AA
Nemeth
Alexander
A
Stavropoulos
S William
SW
Kelly
Peter D
PD
Itkin
Maxim
M
Solomon
Jeffrey A
JA
Shlansky-Goldberg
Richard D
RD
Trerotola
Scott O
SO
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