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Biosynthetic Resorbable Prosthesis is Useful in Single-Stage Management of Chronic Mesh Infection After Abdominal Wall Hernia Repair

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Abstract

Background

The goal of this article was to report the results about the efficacy of treatment of chronic mesh infection (CMI) after abdominal wall hernia repair (AWHR) in one-stage management, with complete mesh explantation of infected prosthesis and simultaneous reinforcement with a biosynthetic poly-4-hydroxybutyrate absorbable (P4HB) mesh.

Methods

This is a retrospective analysis of all patients that needed mesh removal for CMI between September 2016 and January 2019 at a tertiary center. Epidemiological data, hernia characteristics, surgical, and postoperative variables (Clavien–Dindo classification) of these patients were analyzed.

Results

Of the 32 patients who required mesh explantation, 30 received one-stage management of CMI. In 60% of the patients, abdominal wall reconstruction was necessary after the infected mesh removal: 8 cases (26.6%) were treated with Rives–Stoppa repair, 4 (13.3%) with a fascial plication, 1 (3.3%) with anterior component separation, and 1 (3.3%) with transversus abdominis release to repair hernia defects. Three Lichtenstein (10%) and 1 Nyhus repairs (3.3%) were performed in patients with groin hernias. The most frequent postoperative complications were surgical site occurrences: seroma in 5 (20%) patients, hematoma in 2 (6.6%) patients, and wound infection in 1 (3.3%) patient. During the mean follow-up of 34.5 months (range 23–46 months), the overall recurrence rate was 3.3%. Persistent, recurrent, or new CMIs were not observed.

Conclusions

In our experience, single-stage management of CMI with complete removal of infected prosthesis and replacement with a P4HB mesh is feasible with acceptable results in terms of mesh reinfection and hernia recurrence.

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Acknowledgements

We would like to thank Santiago Bonafé, Providencia Garcia-Pastor, Victoria Pareja, José Iserte and Raquel Blasco of our surgical group for their helpful discussions.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

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Authors and Affiliations

  1. Unit of Abdominal Wall Surgery, Department of Digestive Surgery, Hospital Universitari I Politecnic “La Fe”, University of Valencia, Calle Gabriel Miró 28, puerta 12, 46008, Valencia, Spain

    José Bueno-Lledó, Carla Perez-Alonso, Jesús Martinez-Hoed, Antonio Torregrosa-Gallud & Salvador Pous-Serrano

  2. Klinikum Mittelbaden, Balger Strasse 50, 76530, Baden-Baden, Germany

    Marsela Ceno

Authors
  1. José Bueno-Lledó
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  2. Marsela Ceno
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  3. Carla Perez-Alonso
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  4. Jesús Martinez-Hoed
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  5. Antonio Torregrosa-Gallud
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  6. Salvador Pous-Serrano
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Corresponding author

Correspondence to José Bueno-Lledó.

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Conflict of interest

Dr. Bueno-Lledó has been speaker for BD surgical and had grants with BD surgical (workshops). These disclosures do not impact the topics reported herein. All other authors declare no disclosures relevant to this article or research. Drs. Ceno, Perez-Alonso, Martinez-Hoed, Torregrosa-Gallud and Pous-Serrano have no conflicts of interest or financial ties to disclose.

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Bueno-Lledó, J., Ceno, M., Perez-Alonso, C. et al. Biosynthetic Resorbable Prosthesis is Useful in Single-Stage Management of Chronic Mesh Infection After Abdominal Wall Hernia Repair. World J Surg 45, 443–450 (2021). https://doi.org/10.1007/s00268-020-05808-4

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