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Mesh Graft Infection Following Abdominal Hernia Repair: Risk Factor Evaluation and Strategies of Mesh Graft Preservation. A Retrospective Analysis of 476 Operations

World Journal of Surgery volume 34, pages 1702–1709 (2010)Cite this article

Abstract

Background

Mesh graft infection after prosthetic hernia repair is a challenging complication usually treated by mesh removal. The aim of this study was to identify risk factors associated with mesh infection and to assess the efficacy of conservative wound therapy in preserving an infected mesh.

Methods

We performed a retrospective analysis of 476 consecutive patients with incisional hernia who received mesh graft repair between February 1, 2000 and February 28, 2005 at our institution using chart review and clinical investigation.

Results

Thirty-one of 476 (6.5%) patients developed a deep surgical site infection involving the implanted mesh graft. Upon multivariate analysis, operation time was the only significant risk factor associated with mesh infection (p = 0.0038). Seventeen (55%) of 31 infected mesh grafts were preserved by conservative means. There was a significant association between the type of mesh graft used and the probability of mesh preservation in case of infection: While conservative therapy led to preservation of 100% of infected polyglactin/polypropylene meshes, only 20% of infected polypropylene and 23% of infected PTFE/polypropylene meshes could be salvaged using conservative means (p < 0.0001). In none of the patients with preserved mesh graft was hernia recurrence at the former site of infection observed.

Conclusions

Operation time is the only significant risk factor associated with mesh graft infection following incisional hernia repair. Conservative treatment should be applied in case of infection of absorbable mesh grafts such as polypropylene/polyglactin, while nonabsorbable meshes such as PTFE/polypropylene or pure polypropylene are much less amenable to conservative treatment, usually requiring early surgical removal.

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References

  1. Szczerba SR, Dumanian GA (2003) Definitive surgical treatment of infected or exposed ventral hernia mesh. Ann Surg 237(3):437–441

    Article  PubMed  Google Scholar 

  2. Jezupors A, Mihelsons M (2006) The analysis of infection after polypropylene mesh repair of abdominal wall hernia. World J Surg 30(12):2270–2278; discussion 2279–2280

    Article  PubMed  Google Scholar 

  3. Fawole AS, Chaparala RPC, Ambrose NS (2006) Fate of the inguinal hernia following removal of infected prosthetic mesh. Hernia 10(1):58–61

    Article  CAS  PubMed  Google Scholar 

  4. de Vries Reilingh TS, van Geldere D, Langenhorst B et al (2004) Repair of large midline incisional hernias with polypropylene mesh: comparison of three operative techniques. Hernia 8:56–59

    Article  PubMed  Google Scholar 

  5. Langer C, Schaper A, Liersch T et al (2005) Prognosis factors in incisional hernia surgery: 25 years of experience. Hernia 9:16–21

    Article  CAS  PubMed  Google Scholar 

  6. Steenvoorde P, de Roo RA, Oskam J et al (2006) Negative pressure wound therapy to treat peri-prosthetic methicillin-resistant Staphylococcus aureus infection after incisional herniorrhaphy. A case study and literature review. Ostomy Wound Manage 52(1):52–54 [review]

    PubMed  Google Scholar 

  7. Kercher KW, Sing RF, Matthews BD et al (2002) Successful salvage of infected PTFE mesh after ventral hernia repair. Ostomy Wound Manage 48(10):40–42, 44–45

    Google Scholar 

  8. Peterson S, Henke G, Freitag M et al (2001) Deep prosthesis infection in incisional hernia repair: predictive factors and clinical outcome. Eur J Surg 167(6):453–457

    Article  Google Scholar 

  9. National Academy of Sciences/National Research Council (1964) Postoperative wound infections: the influence of ultraviolet irradiation of the operating room and of various other factors. Ann Surg 160(Suppl 2):1–132

    Google Scholar 

  10. Mangram AJ, Horan TC, Pearson ML et al (1999) Guideline for the prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 20(4):250–278

    Article  CAS  PubMed  Google Scholar 

  11. European Wound Management Association (2006) Position document: management of wound infection. Available at http://ewma.org/fileadmin/user_upload/EWMA/pdf/Position_Documents/2006/English_pos_doc_2006.pdf. Accessed 11 November 2009

  12. Pascual G, Rodrígeuz M, Gomez-Gil V et al (2008) Early tissue incorporation and collagen deposition in lightweight polypropylene meshes: bioassay in an experimental model of ventral hernia. Surgery 144(3):427–435

    Article  PubMed  Google Scholar 

  13. Bellón JM, García-Carranza A, García-Honduvilla N et al (2004) Tissue integration and biomechanical behaviour of contaminated experimental polypropylene and expanded polytetrafluoroethylene implants. Br J Surg 91(4):489–494

    Article  PubMed  Google Scholar 

  14. Morykwas MJ, Argenta LC, Shelton-Brown EI (1997) Vacuum-assisted closure: a new method for wound control and treatment: animal studies and basic foundation. Ann Plast Surg 38(6):553–562

    Article  CAS  PubMed  Google Scholar 

  15. Argenta LC, Morykwas MJ (1997) Vacuum-assisted closure: a new method for wound control and treatment: clinical experiences. Ann Plast Surg 38(6):563–577

    Article  CAS  PubMed  Google Scholar 

  16. Timmers MS, Le CS, Banwell P (2005) The effects of varying degrees of pressure delivered by negative-pressure wound therapy on skin perfusion. Ann Plast Surg 55:665–671

    Article  CAS  PubMed  Google Scholar 

  17. Greene AK, Puder M, Roy R et al (2006) Microdeformational wound therapy: effects on angiogenesis and matrix metalloproteinases in chronic wounds of 3 debilitated patients. Ann Plast Surg 56(4):418–422

    Article  CAS  PubMed  Google Scholar 

  18. Kamolz LP, Andel H, Haslik W et al (2004) Use of subatmospheric pressure therapy to prevent burn wound progression in human: first experiences. Burns 30(3):253–258

    Article  PubMed  Google Scholar 

  19. Saxena V, Hwang CW, Huang S et al (2004) Vacuum-assisted closure: microdeformations of wounds and cell proliferation. Plast Reconstr Surg 114(5):1086–1096; discussion 1097–1098

    Article  PubMed  Google Scholar 

  20. Nord D (2006) Cost-effectiveness in wound care. Zentralbl Chir 131(Suppl 1):S185–S188

    Article  PubMed  Google Scholar 

  21. Haridas M, Malangoni MA (2008) Predictive factors for surgical site infection in general surgery. Surgery 144(4):496–501

    Article  PubMed  Google Scholar 

  22. Neumayer L, Hosokawa P, Itani K et al (2007) Multivariable predictors of postoperative surgical site infection after general and vascular surgery: results from the patient safety in surgery study. J Am Coll Surg 204(6):1178–1187

    Article  PubMed  Google Scholar 

  23. Gaynes RP, Culver DH, Horan TC et al (2001) Surgical site infection (SSI) rate in the United States, 1992–1998: the National Nosocomial Infections Surveillance System basic SSI risk index. Clin Infect Dis 33(Suppl 2):S69–S77

    Article  PubMed  Google Scholar 

  24. Leong G, Wilson J, Charlett A (2006) Duration of operation as a risk factor for surgical site infection: comparison of English and US data. J Hosp Infect 63:255–262

    Article  CAS  PubMed  Google Scholar 

  25. Peersman G, Laskin R, Davis J et al (2006) Prolonged operative time correlates with increased infection rate after total knee arthroplasty. HSS J 2:70–72

    Article  CAS  PubMed  Google Scholar 

  26. Olsen MA, Lefta M, Dietz JR et al (2008) Risk factors for surgical site infection after major breast operation. J Am Coll Surg 207(3):326–335

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors thank Christoph Domenig, MD, and Manfred Schoettl, Department of Surgery, Medical University of Vienna, for treating patients and providing their clinical experience for the interpretation of data.

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Affiliations

  1. Department of Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria

    Stefan Stremitzer, Thomas Bachleitner-Hofmann, Bernhard Gradl, Matthias Gruenbeck & Michael Bergmann

  2. Department of Anaesthesia, General Intensive Care and Pain Management, Medical University of Vienna, Vienna, Austria

    Barbara Bachleitner-Hofmann

  3. Core Unit for Medical Statistics and Informatics, Medical University of Vienna, Vienna, Austria

    Martina Mittlboeck

Authors
  1. Stefan Stremitzer
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  2. Thomas Bachleitner-Hofmann
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  3. Bernhard Gradl
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  4. Matthias Gruenbeck
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  5. Barbara Bachleitner-Hofmann
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  6. Martina Mittlboeck
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  7. Michael Bergmann
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Correspondence to Thomas Bachleitner-Hofmann.

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Stremitzer, S., Bachleitner-Hofmann, T., Gradl, B. et al. Mesh Graft Infection Following Abdominal Hernia Repair: Risk Factor Evaluation and Strategies of Mesh Graft Preservation. A Retrospective Analysis of 476 Operations. World J Surg 34, 1702–1709 (2010). https://doi.org/10.1007/s00268-010-0543-z

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  • DOI: https://doi.org/10.1007/s00268-010-0543-z

Keywords

  • Hernia Repair
  • Surgical Site Infection
  • Incisional Hernia
  • Preservation Rate
  • Recurrent Hernia