Case Report

J Minim Invasive Surg 2012; 15(4): 161-164

Published online December 15, 2012

https://doi.org/10.7602/jmis.2012.15.4.161

© The Korean Society of Endo-Laparoscopic & Robotic Surgery

복강경 창상탈장 교정술 후 발생한 Mesh 감염의 치료

이길재ㆍ정민

가천대학교 길병원 외과

Management of Infected Mesh after Laparoscopic Incisional Hernia Repair

Gil Jae Lee, M.D., Min Chung, M.D.

Department of Surgery, Gil Medical Center, Gachon University, Incheon, Korea

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Laparoscopic repair using mesh is a standard technique for ventral hernia repair. Complications of laparoscopic ventral hernia repair increase according to the increment of laparoscopic repair. Subcutaneous emphysema and mesh infection are major complications of laparoscopic repair of ventral hernia. The principle of management of infection is removal of a foreign body. However, in the case of repair with mesh, removal of infected mesh induces recurrence of hernia. Preservation of mesh is the best option for treatment of infected mesh. We have experienced treatment without removal of mesh in a case of infected subcutaneous emphysema after laparoscopic ventral hernia repair. The infection spread slowly to mesh and seroma. Drainage and debridement of infected tissue and evacuation of infected seroma resulted in healing of the infection without removal of mesh.

Keywords Ventral hernia, Laparoscopic surgery, Surgical mesh

  1. A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med 2000;343:392-398.
    Pubmed CrossRef
  2. Falagas ME, Kasiakou SK. Mesh-related infections after hernia repair surgery. Clin Microbiol Infect 2005;11:3-8.
    Pubmed CrossRef
  3. Petersen S, Henke G, Freitag M, Faulhaber A, Ludwig K. Deep prosthesis infection in inc isional hernia repair: predicti ve factors and clinical outcome. Eur J Surg 2001;167:453-457.
    Pubmed CrossRef
  4. 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 2010;34:1702-1709.
    Pubmed CrossRef
  5. Klinge U, Junge K, Spellerberg B, Piroth C, Klosterhalfen B, Schumpelick V. Do multifilament alloplastic meshes increase the infection rate? Analysis of the polymeric surface, the bacteria adherence, and the in vivo consequences in a rat model. J Biomed Mater Res 2002;63:765-771.
    Pubmed CrossRef
  6. Barie PS. Surgical infection and antibiotic use. In: Sabiston DC, Townsend CM, editors. Sabiston textbook of surgery: the biological basis of modern surgical practice. 19th ed. Philadel phia, PA: Elsevier Saunders; 2012. p.240-280.
    CrossRef
  7. Bell ? n JM, Garc ? a-Carranza A, Garc ? a-Honduvilla N, Carrera-San Mart ? n A, Buj ? n J. Tissue integration and biomechanical behaviour of contaminated experimental polypropylene and expanded polytetrafluoroethylen e implants. Br J Surg 2004;91:489-494.
    Pubmed CrossRef
  8. Greenberg J. Can infected composite mesh be salvaged? Hernia 2010;14:589-592.
    Pubmed CrossRef
  9. Murdock CMM, Wolff AJM, Van Geem TM. Risk factors for hypercarbia, subcutaneous emphysema, pneumothorax, and pneumomediastinum during la paroscopy. Obstet Gynecol 2000;95:704-709.
    Pubmed
  10. Bard PAMD, Chen LMD. Subcutaneous emphysema associated with laparoscopy. Anest h Analg 1990;71:101-102.
    Pubmed CrossRef
  11. Bliziotis I, Kasiakou S, Kapaskelis A, Falagas M. Mesh-relat ed infection after hernia repair: case report of an emerging type of foreign-body related infection. Infection 2006;34:46-48.
    Pubmed CrossRef
  12. Gonz ? lez AU, de la Portilla de Juan F, Albarr ? n GC. Large incisional hernia repair using intraperitoneal placement of expanded polytetrafluoroethylene. Am J Surg 1999;177:291-293.
    CrossRef
  13. Engelsman AF, van Dam GM, van der Mei HC, Busscher HJ, Ploeg RJ. In vivo evaluation of bacterial infection involving morphologically different surgical meshes. Ann Surg 2010;251:133-137.
    Pubmed CrossRef
  14. Weyhe D, Schmitz I, Belyaev O, et al. Experimental compariso n of monofile light and heavy polypropylene meshes: less weight does not mean less biological response. World J Surg 2006;30:1586-1591.
    Pubmed CrossRef
  15. Alaedeen D, Lipman J, Medalie D, Rosen M. The single-staged approach to the surgical management of abdominal wall hernias in contaminated fields. Hernia 2007;11:41-45.
    Pubmed CrossRef
  16. Stremitzer S, Bachleitner-Hofmann T, Gradl B, et al. Mesh graft infection following abdomin al hernia repair: risk factor evaluation and strategies of mesh graft preservation. a retrospective analysis of 47 6 operations. World J Surg 2010;34:1702-1709.
    Pubmed CrossRef
  17. Steenvoorde P, de Roo R, Oskam J, Neijenhuis P. Negative pressure wound therapy to treat p eri-prosthetic methicillinresistant staphylococcus aureus infection after incisionaln herniarrhaphy. Ostomy Wound Manage 2006;52:52-54.
    Pubmed
  18. Saettele TM, Bachman SL, Costello CR, et al. Use of porcine dermal collagen as a prosthetic mesh in a contaminated field for ventral hernia repair: a case report. Hernia 2007;11:279-285.
    Pubmed CrossRef

Article

Case Report

J Minim Invasive Surg 2012; 15(4): 161-164

Published online December 15, 2012 https://doi.org/10.7602/jmis.2012.15.4.161

Copyright © The Korean Society of Endo-Laparoscopic & Robotic Surgery.

복강경 창상탈장 교정술 후 발생한 Mesh 감염의 치료

이길재ㆍ정민

가천대학교 길병원 외과

Management of Infected Mesh after Laparoscopic Incisional Hernia Repair

Gil Jae Lee, M.D., Min Chung, M.D.

Department of Surgery, Gil Medical Center, Gachon University, Incheon, Korea

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Laparoscopic repair using mesh is a standard technique for ventral hernia repair. Complications of laparoscopic ventral hernia repair increase according to the increment of laparoscopic repair. Subcutaneous emphysema and mesh infection are major complications of laparoscopic repair of ventral hernia. The principle of management of infection is removal of a foreign body. However, in the case of repair with mesh, removal of infected mesh induces recurrence of hernia. Preservation of mesh is the best option for treatment of infected mesh. We have experienced treatment without removal of mesh in a case of infected subcutaneous emphysema after laparoscopic ventral hernia repair. The infection spread slowly to mesh and seroma. Drainage and debridement of infected tissue and evacuation of infected seroma resulted in healing of the infection without removal of mesh.

Keywords: Ventral hernia, Laparoscopic surgery, Surgical mesh

References

  1. A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med 2000;343:392-398.
    Pubmed CrossRef
  2. Falagas ME, Kasiakou SK. Mesh-related infections after hernia repair surgery. Clin Microbiol Infect 2005;11:3-8.
    Pubmed CrossRef
  3. Petersen S, Henke G, Freitag M, Faulhaber A, Ludwig K. Deep prosthesis infection in inc isional hernia repair: predicti ve factors and clinical outcome. Eur J Surg 2001;167:453-457.
    Pubmed CrossRef
  4. 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 2010;34:1702-1709.
    Pubmed CrossRef
  5. Klinge U, Junge K, Spellerberg B, Piroth C, Klosterhalfen B, Schumpelick V. Do multifilament alloplastic meshes increase the infection rate? Analysis of the polymeric surface, the bacteria adherence, and the in vivo consequences in a rat model. J Biomed Mater Res 2002;63:765-771.
    Pubmed CrossRef
  6. Barie PS. Surgical infection and antibiotic use. In: Sabiston DC, Townsend CM, editors. Sabiston textbook of surgery: the biological basis of modern surgical practice. 19th ed. Philadel phia, PA: Elsevier Saunders; 2012. p.240-280.
    CrossRef
  7. Bell ? n JM, Garc ? a-Carranza A, Garc ? a-Honduvilla N, Carrera-San Mart ? n A, Buj ? n J. Tissue integration and biomechanical behaviour of contaminated experimental polypropylene and expanded polytetrafluoroethylen e implants. Br J Surg 2004;91:489-494.
    Pubmed CrossRef
  8. Greenberg J. Can infected composite mesh be salvaged? Hernia 2010;14:589-592.
    Pubmed CrossRef
  9. Murdock CMM, Wolff AJM, Van Geem TM. Risk factors for hypercarbia, subcutaneous emphysema, pneumothorax, and pneumomediastinum during la paroscopy. Obstet Gynecol 2000;95:704-709.
    Pubmed
  10. Bard PAMD, Chen LMD. Subcutaneous emphysema associated with laparoscopy. Anest h Analg 1990;71:101-102.
    Pubmed CrossRef
  11. Bliziotis I, Kasiakou S, Kapaskelis A, Falagas M. Mesh-relat ed infection after hernia repair: case report of an emerging type of foreign-body related infection. Infection 2006;34:46-48.
    Pubmed CrossRef
  12. Gonz ? lez AU, de la Portilla de Juan F, Albarr ? n GC. Large incisional hernia repair using intraperitoneal placement of expanded polytetrafluoroethylene. Am J Surg 1999;177:291-293.
    CrossRef
  13. Engelsman AF, van Dam GM, van der Mei HC, Busscher HJ, Ploeg RJ. In vivo evaluation of bacterial infection involving morphologically different surgical meshes. Ann Surg 2010;251:133-137.
    Pubmed CrossRef
  14. Weyhe D, Schmitz I, Belyaev O, et al. Experimental compariso n of monofile light and heavy polypropylene meshes: less weight does not mean less biological response. World J Surg 2006;30:1586-1591.
    Pubmed CrossRef
  15. Alaedeen D, Lipman J, Medalie D, Rosen M. The single-staged approach to the surgical management of abdominal wall hernias in contaminated fields. Hernia 2007;11:41-45.
    Pubmed CrossRef
  16. Stremitzer S, Bachleitner-Hofmann T, Gradl B, et al. Mesh graft infection following abdomin al hernia repair: risk factor evaluation and strategies of mesh graft preservation. a retrospective analysis of 47 6 operations. World J Surg 2010;34:1702-1709.
    Pubmed CrossRef
  17. Steenvoorde P, de Roo R, Oskam J, Neijenhuis P. Negative pressure wound therapy to treat p eri-prosthetic methicillinresistant staphylococcus aureus infection after incisionaln herniarrhaphy. Ostomy Wound Manage 2006;52:52-54.
    Pubmed
  18. Saettele TM, Bachman SL, Costello CR, et al. Use of porcine dermal collagen as a prosthetic mesh in a contaminated field for ventral hernia repair: a case report. Hernia 2007;11:279-285.
    Pubmed CrossRef

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