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Management of Infected Mesh After Lichtenstein Hernia Repair: a Systematic Review

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Abstract

Inguinal hernia repair with mesh is one of the most common operations performed by general surgeons. Mesh infection is a rare complication that has detrimental effects on the patient and the healthcare system. The purpose of this systematic review was to determine an evidence-based management approach for patients with infected mesh following an open Lichtenstein inguinal hernia repair. The literature search was achieved using the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines (PRISMA). The quality of the papers was assessed using Grading of Recommendations Assessment Development and Evaluation (GRADE) criteria. Studies were analysed by two independent reviewers. A total of 1532 abstracts and articles were reviewed. Fourteen met the inclusion criteria. In most, the mesh used was either monofilament or multifilament polypropylene. Most (86.8%) underwent mesh removal despite attempts at conservative management. Universally, in the presence of sinus formation (infected mesh to skin), mesh removal was required for definite resolution of infection. After a period of conservative management, removal of infected mesh following Lichtenstein inguinal hernia repair may be recommended. However, the quality of evidence is poor. Techniques such as partial removal or use of negative pressure dressings may need to be further explored.

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Acknowledgments

This research was undertaken as part of the third year of the MSc in Surgical Sciences or Edinburgh Surgical Sciences Qualification www.essq.rcsed.ac.uk

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Authors and Affiliations

  1. Acute Surgical Unit, Fiona Stanley Hospital, Murdoch, Western Australia, 6150, Australia

    Amelie Maurel

  2. Acute Surgical Unit, Fiona Stanley Hospital, Murdoch, Western Australia, 6150, Australia

    Darren Karadimos

  3. Logan Hospital, Corner Armstrong and Loganlea Roads, Meadowbrook, Queensland, 4131, Australia

    Arkadiusz Peter Wysocki

Authors
  1. Amelie Maurel
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  2. Darren Karadimos
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  3. Arkadiusz Peter Wysocki
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Contributions

Dr. Amelie Maurel: study conception and design, acquisition of data, analysis and interpretation of data, drafting of manuscript

Dr. Darren Karadimos: acquisition of data, analysis and interpretation of data

Dr. Arkadiusz Peter Wysocki: study conception and design, analysis and interpretation of data, critical revision of manuscript

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Correspondence to Amelie Maurel.

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For this type of study, formal consent was not required.

This article does not contain any studies with human participants or animals performed by any of the authors.

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Informed consent was not required to undertake this systematic review.

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Maurel, A., Karadimos, D. & Wysocki, A.P. Management of Infected Mesh After Lichtenstein Hernia Repair: a Systematic Review. SN Compr. Clin. Med. 1, 730–736 (2019). https://doi.org/10.1007/s42399-019-00114-0

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