Biosynthetic Resorbable Prosthesis is Useful in Single-Stage Management of Chronic Mesh Infection After Abdominal Wall H
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ORIGINAL SCIENTIFIC REPORT
Biosynthetic Resorbable Prosthesis is Useful in Single-Stage Management of Chronic Mesh Infection After Abdominal Wall Hernia Repair Jose´ Bueno-Lledo´1 • Marsela Ceno2 • Carla Perez-Alonso1 • Jesu´s Martinez-Hoed1 Antonio Torregrosa-Gallud1 • Salvador Pous-Serrano1
•
Accepted: 20 September 2020 Ó Socie´te´ Internationale de Chirurgie 2020
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.
Introduction
& Jose´ Bueno-Lledo´ [email protected] 1
Unit of Abdominal Wall Surgery, Department of Digestive Surgery, Hospital Universitari I Politecnic ‘‘La Fe’’, University of Valencia, Calle Gabriel Miro´ 28, puerta 12, 46008 Valencia, Spain
2
Klinikum Mittelbaden, Balger Strasse 50, 76530 Baden-Baden, Germany
Chronic mesh infection (CMI) is one of the most devastating complications after abdominal wall hernia repair (AWHR) [1]. Prosthesis explantation has been recommended when an infection is not resolved through conservative measures. However, the placement of new mesh during explantation has not been universally accepted. There is a high possibility of prosthesis reinfection even with biological scaffolds or permanent synthetic meshes [2]. Consequently, two-stage management has been recommended as the ideal approach. This often results in the need for surgical procedures, such as autologous flap
123
World J Surg
reconstruction or addit
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