Conservative management of mesh-site infection in hernia repair.

Brenda Aguilar, Alyssa B. Chapital, James A. Madura, Kristi L. Harold

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)249-252
Number of pages4
JournalJournal of laparoendoscopic & advanced surgical techniques. Part A
Volume20
Issue number3
StatePublished - Apr 2010
Externally publishedYes

Fingerprint

Herniorrhaphy
Abdominal Wall
Infection
Polytetrafluoroethylene
Ventral Hernia
Anti-Bacterial Agents
Drainage
Staphylococcus lugdunensis
Abdominal Hernia
Seroma
Enterococcus faecalis
Conservative Treatment
Gentamicins
Staphylococcus aureus
Sepsis
Escherichia coli
Therapeutics

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Aguilar, B., Chapital, A. B., Madura, J. A., & Harold, K. L. (2010). Conservative management of mesh-site infection in hernia repair. Journal of laparoendoscopic & advanced surgical techniques. Part A, 20(3), 249-252.

Conservative management of mesh-site infection in hernia repair. / Aguilar, Brenda; Chapital, Alyssa B.; Madura, James A.; Harold, Kristi L.

In: Journal of laparoendoscopic & advanced surgical techniques. Part A, Vol. 20, No. 3, 04.2010, p. 249-252.

Research output: Contribution to journalArticle

Aguilar, B, Chapital, AB, Madura, JA & Harold, KL 2010, 'Conservative management of mesh-site infection in hernia repair.', Journal of laparoendoscopic & advanced surgical techniques. Part A, vol. 20, no. 3, pp. 249-252.
Aguilar, Brenda ; Chapital, Alyssa B. ; Madura, James A. ; Harold, Kristi L. / Conservative management of mesh-site infection in hernia repair. In: Journal of laparoendoscopic & advanced surgical techniques. Part A. 2010 ; Vol. 20, No. 3. pp. 249-252.
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