title: Increased use of surgical energy promotes methicillin-resistant Staphylococcus aureus colonization in rabbits following open ventral hernia mesh repair.
abstract: Surgical energy has been widely implemented because of ease of use, effective hemostasis, and surgical dissection. Studies demonstrate its use to be an independent risk factor for postoperative wound infection. Methicillin-resistant Staphylococcus aureus (MRSA) is the most common bacteria found in postoperative mesh infection. No reports are available on the sequelae of surgical energy use for open ventral hernia repair (oVHR) with mesh. We hypothesized that increasing amounts of surgical energy will result in higher infectious burden after oVHR with composite multifilament polyester mesh (Parietex™ PCO).
  
  
  
  New Zealand rabbits underwent bridging oVHR with Parietex™ PCO and were divided into three surgical treatment groups: (1) scalpel alone, (2) 120 J of energy, and (3) 600 J of energy. The bioprosthesis was then inoculated with 105colony-forming units of MRSA. Rabbits were survived for 7 days with daily physical examination. Complete blood count, basci metabolic panel, and blood cultures were performed on postoperative days one, four, and seven. Surviving rabbits were killed, and meshes explanted for MRSA colony counts.
  
  
  
  Rabbits receiving the most surgical energy developed signs and symptoms of severe sepsis and wound necrosis within 24 h. In comparison, rabbits receiving no surgical energy had significantly less MRSA recovered from explanted mesh, significantly less bacteremia, and fewer adhesions.
  
  
  
  Increased use of surgical energy promoted greater colonization, exaggerated septic response to bacterial contamination, and more severe adhesions. In the absence of devitalized tissue, rabbits can effectively limit bacterial contamination. These findings support the surgical principles of proper tissue handling and highlight the detrimental effects of indiscriminant surgical energy usage, thus emphasizing the importance of programs such as Fundamental Use of Surgical Energy.
authors.affiliation: Department of Surgery, Houston Methodist Hospital, 6565 Fannin St., Suite 1660, Houston, TX, 77030, USA. JSFernandez-Moure@houstonmethodist.org.|Surgical Advanced Technologies Lab, Department of Nanomedicine, Houston Methodist Research Institute, 6670 Bertner Ave., Houston, TX, 77030, USA. JSFernandez-Moure@houstonmethodist.org.
authors.forename: Joseph S
authors.identifier: 0000-0003-1397-6320
authors.initials: JS
authors.lastname: Fernandez-Moure
authors.affiliation: Department of Surgery, Houston Methodist Hospital, 6565 Fannin St., Suite 1660, Houston, TX, 77030, USA.|Surgical Advanced Technologies Lab, Department of Nanomedicine, Houston Methodist Research Institute, 6670 Bertner Ave., Houston, TX, 77030, USA.
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Van Eps
authors.affiliation: Surgical Advanced Technologies Lab, Department of Nanomedicine, Houston Methodist Research Institute, 6670 Bertner Ave., Houston, TX, 77030, USA.
authors.forename: Lilia
authors.initials: L
authors.lastname: Peress
authors.affiliation: Department of Pathology and Genomic Medicine, Houston Methodist Hospital, 6565 Fannin St., Houston, TX, 77030, USA.
authors.forename: Concepcion
authors.initials: C
authors.lastname: Cantu
authors.affiliation: Department of Pathology and Genomic Medicine, Houston Methodist Hospital, 6565 Fannin St., Houston, TX, 77030, USA.
authors.forename: Randall J
authors.initials: RJ
authors.lastname: Olsen
authors.affiliation: Surgical Advanced Technologies Lab, Department of Nanomedicine, Houston Methodist Research Institute, 6670 Bertner Ave., Houston, TX, 77030, USA.
authors.forename: Leslie
authors.initials: L
authors.lastname: Jenkins
authors.affiliation: Surgical Advanced Technologies Lab, Department of Nanomedicine, Houston Methodist Research Institute, 6670 Bertner Ave., Houston, TX, 77030, USA.
authors.forename: Fernando J
authors.initials: FJ
authors.lastname: Cabrera
authors.affiliation: Surgical Advanced Technologies Lab, Department of Nanomedicine, Houston Methodist Research Institute, 6670 Bertner Ave., Houston, TX, 77030, USA.
authors.forename: Ennio
authors.initials: E
authors.lastname: Tasciotti
authors.affiliation: Department of Surgery, Houston Methodist Hospital, 6565 Fannin St., Suite 1660, Houston, TX, 77030, USA.|Department of Orthopedic Surgery, Houston Methodist Hospital, 6565 Fannin St., Houston, TX, 77030, USA.
authors.forename: Bradley K
authors.initials: BK
authors.lastname: Weiner
authors.affiliation: Department of Surgery, Houston Methodist Hospital, 6565 Fannin St., Suite 1660, Houston, TX, 77030, USA. BJDunkin@houstonmethodist.org.|The Methodist Institute for Technology, Innovation, and Education (MITIE), 6670 Bertner Ave, Houston, TX, 77030, USA. BJDunkin@houstonmethodist.org.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Dunkin
mesh_terms: D000818:Animals; D003094:Collagen; D004564:Electrocoagulation / Q000379:methods*; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D055624:Methicillin-Resistant Staphylococcus aureus; D011091:Polyesters; D016459:Prosthesis-Related Infections / Q000453:epidemiology* / Q000382:microbiology; D011817:Rabbits; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology* / Q000382:microbiology; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology; D013526:Surgical Mesh; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000382:microbiology
chemical_list: D011091:Polyesters; C588279:parietex; D003094:Collagen
keywords: Diathermy; FUSE; Hernia; Infection; Mesh; Surgical energy