The early outcomes of complex abdominal wall reconstruction with polyvinylidene (PVDF) mesh in the setting of active infection: a prospective series.

PURPOSE: The use of synthetic mesh to repair infected abdominal wall defects remains controversial. Polyvinylidene fluoride (PVDF) mesh was introduced in 2002 as an alternative to polypropylene, with the advantages of improved biostability, lowered bending stiffness, and minimum tissue response. This study aimed to evaluate the short-term outcomes of using PVDF mesh to treat infected abdominal wall defects in the elective setting. METHODS: This prospective clinical trial started in 2016 and was designed to evaluate the short- and mid-term outcomes of 38 patients submitted to abdominal wall reconstruction in the setting of active mesh infection and/or enteric fistulas (AI) when compared to a group of 38 patients submitted to clean ventral hernia repairs (CC). Patients were submitted to single-staged repairs, using onlay PVDF mesh (DynaMesh®-CICAT) reinforcement to treat their defects. RESULTS: Groups had comparable demographic characteristics. The AI group had more previous abdominal operations and required a longer operative and anesthesia time. At 30 days, surgical site occurrences were observed in 16 (42.1%) AI vs. 17 (44.7%) CC, p = 0.817; surgical site infection occurred in 4 (10.5%) AI vs. 6 (15.8%) CC, p = 0.497; and a higher number of procedural interventions were required in the CC group, 15.8 AI vs. 28.9% CC, p = 0.169. Both groups did not have chronic infections at 1 year of follow-up, and one hernia recurrence was observed in the AI group. CONCLUSIONS: The use of PVDF mesh in the infected setting presented favorable results with a low incidence of wound infection.

Mycobacterium bovis infection of an aortobifemoral bypass graft with Streptococcus intermedius superinfection after intravesical bacillus Calmette-Guérin immunotherapy for bladder cancer.

BACKGROUND: The Bacillus Calmette-Guerin (BCG) is a life-attenuated form of Mycobacterium bovis widely used as immunotherapy for localized bladder cancer. Adverse reactions to intravesical BCG instillations are rare. CASE: We describe a 70-year-old man with a history of an aortobifemoral bypass graft, placement of a synthetic mesh for treatment of a ventral hernia and, most recently, superficial bladder cancer treated with BCG therapy. Ten months after his final intravesical BCG instillation, he complained of fever and asthenia. After 12 months of investigation, he was diagnosed with Mycobacterium bovis infection of his aortobifemoral bypass graft and abdominal mesh, with Streptococcus intermedius superinfection. The bypass graft was excised and replaced with an in situ arterial allograft, the abdominal mesh was removed, and treatment started with amoxicillin, isoniazid, rifampicin and ethambutol. Several additional vascular interventions were needed for allograft degradation, but 12 months after the final procedure, outcome was good. DISCUSSION AND CONCLUSIONS: Among 35 cases of mycotic aneurysm reported after BCG therapy in the last 10 years, only one involved a vascular prosthesis. Surgical repair of such aneurysms using prosthetic grafts is commonly performed, associated with anti-mycobacterial treatment. Prognosis is poor with mortality of 14% (4/35) and a 26% rate of aneurysm recurrence under treatment (9/35).

Laparoscopic partial sacrocolpopexy mesh resection due to mesh infection.

PURPOSE: Sacrocolpopexy is considered the gold-standard procedure for apical compartment prolapse and has become a widely used intervention strategy. The mesh material used in the surgical treatment of pelvic organ prolapse is associated with significant complications in some cases, frequently managed conservatively but sometimes necessitating mesh excision for symptom relief. METHODS: In this video we present the case of a 49-year-old woman who after sacrocolpopexy reported foul-smelling discharge as the only symptom. The patient was treated with vaginocervical seroma debridement and removal of large parts of the mesh and paravaginal tissue. A methodical procedure including retroperitoneal dissection along with identification of the anatomical landmarks is critical in cases of suspected mesh infection and facilitates the procedure. RESULTS: The operation does not include a complete mesh excision in order to avoid major surgery and to reduce the risk of recurrent prolapse. In the follow-up visits at 1 and 6 months postoperatively the patient was asymptomatic. CONCLUSION: Synthetic mesh activates an inflammatory process that leads to surrounding tissue fibrosis and scar tissue formation that can distort the pelvic anatomy (Chamsy and Lee in J Minim Invasive Gynecol. 21(6):986, 2014), thereby making dissection more difficult. This surgical procedure requires a comprehensive knowledge of the pelvic anatomy and a methodical surgical strategy.

Squamous-cell carcinoma due to mesh infection after umbilical hernia operation: third case of the literature.

INTRODUCTION: Polypropylene (PP) meshes are safe synthetic products used for hernia repairs and associated with minimal complication. Chronic inflammation is thought to play a pathophysiological role in the development of cancer.Case presentation: We present a 67-year-old female case of squamous cell-cancer (SCC) that developed due to mesh after umbilical hernia operation. The mass in the anterior abdominal wall was totally resected. Pathology was reported as T2N0, moderately differentiated acantholytic type SCC. No recurrence or complication was detected in the fourth-month follow-up. CONCLUSION: Cancer development after mesh is very rare and our case is the third case in the literature. Cancer development should be kept in mind in patients presenting with ulcerated masses if do not regress with infection treatment after mesh application.

Chronic encysted giant seroma post-ventral hernia repair masquerading as peritoneal cyst and its laparo-seroscopic management: A case report and literature review.

Seroma formation is one the most common occurrence post-ventral hernia repair, with varied presentation from asymptomatic collection to infected collection to chronic collection, which may sometimes present as a diagnostic dilemma and therapeutic challenge. We report a case of giant abdominal swelling presenting as an encysted peritoneal cyst, which was ultimately found to be a chronic seroma and was managed successfully with combined laparo-seroscopic approach.

Risks of subsequent abdominal operations after laparoscopic ventral hernia repair.

INTRODUCTION: Laparoscopic ventral hernia repair (LVHR) with intraperitoneal mesh placement is well established; however, the fate of patients requiring future abdominal operations is not well understood. This study identifies the characteristics of LVHR patients undergoing reoperation and the sequelae of reoperation. METHODS: A retrospective review of a prospectively maintained database at a hernia referral center identified patients who underwent LVHR between 2005 and 2014 and then underwent a subsequent abdominal operation. The outcomes of those reoperations were collected. Data are presented as a mean with ranges. RESULTS: A total of 733 patients underwent LVHR. The average age was 56.5 years, BMI 33.9 kg/m2, hernia size 115 cm2 (range 1-660 cm2), and mesh size 411 cm2 (range 17.7-1360 cm2). After a mean follow-up of 19.4 months, the overall hernia recurrence rate was 8.4 %. Subsequent abdominal operations were performed in 17 % (125 patients) at a mean 2.2 years. The most common indication for reoperation was recurrent hernia (33 patients, 26.4 %), followed by bowel obstruction (18 patients, 14.4 %), hepatopancreaticobiliary (17 patients, 13.6 %) and infected mesh removal (15 patients, 12 %), gynecologic (10 patients, 8 %), colorectal (8 patients, 6.4 %), bariatric (4 patients, 3 %), trauma (1 patient, 0.8 %), and other (19 patients, 15 %). The overall incidence of enterotomy or unplanned bowel resection (EBR) at reoperation was 4 %. This occurred exclusively in those reoperated for complete bowel obstruction, and the reason for EBR was mesh-bowel adhesions. No other indication for reoperation resulted in EBR. The incidence of secondary mesh infection after subsequent operation was 2.4 %. CONCLUSION: In a large consecutive series of LVHR, the rate of abdominal reoperation was 17 %. Generally, these reoperations can be performed safely. A reoperation for bowel obstruction, however, may carry an increased risk of EBR as a direct result of mesh-bowel adhesions. Secondary mesh infection after reoperation, although rare, may also occur. Surgeons should discuss with their patients the potential long-term implications of having an intraperitoneal mesh and how it may impact future abdominal surgery.

Eradication of multidrug-resistant pseudomonas biofilm with pulsed electric fields.

Biofilm formation is a significant problem, accounting for over eighty percent of microbial infections in the body. Biofilm eradication is problematic due to increased resistance to antibiotics and antimicrobials as compared to planktonic cells. The purpose of this study was to investigate the effect of Pulsed Electric Fields (PEF) on biofilm-infected mesh. Prolene mesh was infected with bioluminescent Pseudomonas aeruginosa and treated with PEF using a concentric electrode system to derive, in a single experiment, the critical electric field strength needed to kill bacteria. The effect of the electric field strength and the number of pulses (with a fixed pulse length duration and frequency) on bacterial eradication was investigated. For all experiments, biofilm formation and disruption were confirmed with bioluminescent imaging and Scanning Electron Microscopy (SEM). Computation and statistical methods were used to analyze treatment efficiency and to compare it to existing theoretical models. In all experiments 1500 V are applied through a central electrode, with pulse duration of 50 µs, and pulse delivery frequency of 2 Hz. We found that the critical electric field strength (Ecr) needed to eradicate 100-80% of bacteria in the treated area was 121 ± 14 V/mm when 300 pulses were applied, and 235 ± 6.1 V/mm when 150 pulses were applied. The area at which 100-80% of bacteria were eradicated was 50.5 ± 9.9 mm(2) for 300 pulses, and 13.4 ± 0.65 mm(2) for 150 pulses. 80% threshold eradication was not achieved with 100 pulses. The results indicate that increased efficacy of treatment is due to increased number of pulses delivered. In addition, we that showed the bacterial death rate as a function of the electrical field follows the statistical Weibull model for 150 and 300 pulses. We hypothesize that in the clinical setting, combining systemic antibacterial therapy with PEF will yield a synergistic effect leading to improved eradication of mesh infections.

A single-centre experience of relaparoscopy in complications of laparoscopic inguinal hernia repair-feasibility and outcomes.

BACKGROUND: Management of complications of laparoscopic inguinal hernia repair remains challenging as well as debatable. Relaparoscopy in management of these complications is relatively newer concept. We tried to analyse the feasibility of relaparoscopy (transabdominal preperitoneal approach) in management of complications of laparoscopic inguinal hernia repair. MATERIALS AND METHODS: The study group included 61 patients (referral cases) from a prospectively maintained database of previous laparoscopic inguinal hernia surgery with majority of the patients of recurrence (n = 39). Other complications were mesh infections (n = 15), pubic osteitis (n = 3), migration of mesh into adjacent viscera (n = 3) and meralgia paresthetica (n = 1). All patients underwent transabdominal preperitoneal approach (TAPP) between January 2007 and December 2013. RESULTS AND OUTCOME: Most of the patients had previous TEP repair (n = 49) with variable complications detected in the range of 9 days to 38 months. Small-sized mesh (n = 12) and rolled up mesh (n = 10) were the causes of recurrence in 57 % cases. Mycobacterium tuberculosis (40 %) and mixed bacterial infections (33 %) strains were detected in the infected mesh. Pubic osteitis and meralgia paresthetica were tackers induced. All patients dealt with TAPP approach. Recurrent hernia cases underwent mesh placement and infected mesh was removed in mesh infection. Tackers were removed in cases of osteitis pubis and meralgia paraesthesia. Median operative time was 62 min (42-126 min) and hospital stay 3 days (2-13 days). The relaparoscopy was accomplished in 95.1 % of cases with no major intraoperative complications and minimal postoperative morbidity. CONCLUSION: Relaparoscopy through TAPP approach remains safe and feasible option to deal with primary laparoscopic hernia repair complications. Surgical techniques during primary laparoscopic repair are important cause for aforementioned complications. Though, surgical expertize remains warranted for relaparoscopy.

First case of mesh infection due to Coccidioides spp. and literature review of fungal mesh infections after hernia repair.

Fungal mesh infections are a rare complication of hernia repairs with mesh. The first case of Coccidioides spp. mesh infection is described, and a systematic literature review of all known fungal mesh infections was performed. Nine cases of fungal mesh infection are reviewed. Female and male patients are equally represented, median age is 49.5 years, and critical illness and preinfection antibiotic use were common. Fungal mesh infections are rare, but potentially fatal, complications of hernias repaired with mesh.

The Great Debate: Mesh or No Mesh in Contaminated Hernia Repairs?

Abdominal hernia surgeries are commonly performed with many different approaches, and mesh utilization has become a cornerstone in hernia repair, ensuring durable outcomes with minimal recurrence risk. However, managing contaminated hernia repairs presents unique challenges due to the heightened risks of mesh infection. Recent advancements in lightweight macroporous polypropylene meshes offer promising solutions. Studies have highlighted the superiority of macroporous polypropylene meshes compared to primary suture repair and other mesh types in terms of reduced surgical site infection rates and lower hernia recurrence rates. Moreover, utilizing macroporous polypropylene mesh in the retrorectus plane is associated with a favorable salvage rate, underscoring its efficacy in contaminated hernia repairs. At the same time, contrary evidence suggests higher postoperative complications with mesh use in settings of clean-contaminated or contaminated fields. Most significant complications are increased infection rates and similar recurrence rates compared to mesh-free repairs. New synthetic mesh that is being marketed as having better outcomes than other types of mesh and potentially primary repair need to be carefully assessed as biologic mesh once used to also be touted as the mesh to use in such fields, but more research is showing higher complication rates. The risk of infection and consequent morbidity might outweigh the benefit of less recurrence risk with mesh use. Further research, including prospective studies with long-term follow-up, is warranted to elucidate optimal hernia repair strategies in contaminated fields and inform evidence-based practice guidelines.

Long-term results with biosynthetic absorbable P4HB mesh in ventral abdominal wall repair: a multicentre analysis.

BACKGROUND: The aim of this multicentre study was to analyse the outcomes of biosynthetic absorbable poly-4-hydroxybutyrate (P4HB) prosthesis implantation in patients undergoing ventral hernia repair (VHR) in the context of different degrees of contamination. METHODS: From May 2016 to December 2021, a multicentre retrospective analysis of patients who underwent elective or urgent hernia repair with P4HB prosthesis was performed in seven hospitals in Spain and Portugal. Patients with a postoperative follow-up of less than 20 months and those within the theoretical period of prosthesis resorption were excluded from the study. Regarding the degree of contamination, patients were assessed according to the modified Ventral Hernia Working Group (VHWG) classification. Epidemiological data, hernia characteristics, surgical and postoperative variables (Clavien-Dindo classification) of these patients were analyzed. Risk factors related to long-term recurrence were studied by a multivariate analysis. RESULTS: In 236 cases of P4HB prosthesis implantation, repair in cases of Grade 3 was the most frequent (49.1%), followed by Grade 2 in 42.3% of cases and Grade 1 in 8.4%. The most frequent complications were Grade 1, with the majority occurring during the first year. The overall rate of surgical site occurrences (SSO) was 30%. The hernia recurrence rate was 14.4% (n = 34), with a mean postoperative follow-up time of 41 months (22-61). The multivariate analysis showed that the onlay location of the mesh (OR 1.07; CI 1.42-2.70, p = 0.004) was a significant independent risk factor for recurrence. CONCLUSIONS: The use of a P4HB bioresorbable mesh for the VHR with different degrees of contamination leads to favourable results overall, with an acceptable rate of hernia recurrence. The onlay location of the P4HB prosthesis is the main factor in recurrence in both elective and emergency settings.

Treatment of mesh infection after inguinal hernia repair: 3-year experience with 120 patients.

PURPOSE: Mesh infection is a devastating complication of sterile hernia repair surgery. This study was performed to assess the short- and long-term outcomes following treatment for mesh infection after inguinal hernia repair. METHODS: This single-center retrospective study included all patients who developed mesh infection after inguinal hernia repair from January 2018 to December 2020. Patient demographics, mesh infection characteristics, microbiology, features of surgery, short- and long-term outcomes, and follow-up data were analyzed. RESULTS: In total, 120 patients (8 women, 112 men; mean age, 54.4 years; mean body mass index, 24.8 kg/m2) were treated for mesh infection. The cultures were positive in 88 patients; 62.5% of these were positive for Staphylococcus aureus. Laparoscopic exploration was performed in 108 patients. Seventy patients underwent complete removal of infected mesh, and 50 underwent partial removal. During the short-term follow-up, 11 patients developed a minor wound infection and were treated with dressings and antibiotics, 1 developed a wound infection requiring debridement, 30 developed seromas, and 3 developed hematomas that did not require surgical intervention. During the mean follow-up of 39.1 months, 4 patients developed hernia recurrence, 2 experienced chronic pain, and 23 developed recurrent infection requiring reoperation in the partial mesh removal group (in contrast, only 4 patients in the complete mesh removal group developed recurrent infection, with a statistically significant difference). CONCLUSION: The outcome of mesh infection after inguinal hernia repair treated by mesh removal is satisfactory. Systematic individualized treatment by experienced experts based on the patient's previous repair technique, implanted mesh, and physical condition is recommended.

Gastrointestinal procedures and anastomoses can be safely performed during complex abdominal wall reconstruction.

INTRODUCTION: The literature regarding combined abdominal wall reconstruction and gastrointestinal surgery is limited and largely suggests staged procedures due to a reported increased incidence of surgical site infections (SSIs), hernia recurrence and anastomotic leak, but this exposes patients to the risks of two substantial procedures. This study evaluates the outcomes of single-stage GI surgery with complex abdominal wall reconstructions (CAWR) by a single surgeon. METHODS: Analysis of 10 years of a prospectively maintained single surgeon CAWR database compared those who had CAWR-alone with those having concomitant gastrointestinal surgery (CAWR-GI) such as stoma reversal or bowel resection but excluding cholecystectomy, gynaecological surgery and adhesiolysis alone. Groups were compared using the paired t test (continuous data) and Fisher's exact test (nominal data). RESULTS: Overall, 62 elective cases (42 CAWR-alone vs. 20 CAWR-GI) were analysed. Baseline demographics (age, BMI, co-morbidities, smoking status and hernia size) showed no differences; CAWR-GI mean operating time was significantly longer compared to the CAWR-alone group (5.4 h vs. 4.1 h) with an increased incidence of post-operative ileus in the intestinal group (40% vs. 11.9%, p < 0.05). Post-operative complications were common (chest infection (32.3%) and SSI (41.9%)), but similar between groups. There were no anastomotic leaks, and the hernia recurrence rate at almost 4 years median follow-up was 10% in both groups. CONCLUSION: Performing simultaneous intestinal surgery during complex abdominal wall repair can be performed safely without increasing the risk of hernia recurrence, mesh infections or anastomotic leak. A careful choice of mesh implant is required.

Simultaneous hernia repair following robotic-assisted radical prostatectomy is safe with low rates of mesh-related complications.

Robotic-assisted radical prostatectomy (RARP) is the gold-standard treatment for localized prostate cancer in the USA. However, performing RARP along with a concomitant hernia repair with mesh is debatable because of the lack of well-designed studies on this subject. Some argue that this procedure may result in mesh infections and increased complications due to possible contact of mesh and urine. This study reports our experience with simultaneous hernia repair with mesh placement in patients who underwent radical prostatectomy. We compared 244 patients (from August 2008 to August 2021) who underwent RARP with concomitant hernia repair (inguinal, umbilical, and ventral) and mesh placement with 244 patients from 6275 RARPs operated on the same period without hernia repair. We performed a propensity score matching analysis using preoperative covariates and compared the perioperative outcomes, and complications in 90 days after surgery. Median follow-up was 36.6 months for the control and hernia groups respectively (p = 0.81). Eighty-three patients had unilateral inguinal hernia repair, 22 had a bilateral inguinal hernia repair, 95 had a ventral hernia repair, and 44 had an umbilical hernia repair. The median operative time was 112 min for the control group and 160 min for hernia groups (p < 0.001). We did not find statistically significant differences in minor complications (Clavien ≤ 2). Although the postoperative readmissions in 90-days were higher in the hernia group (18 vs. 7, p = 0.038), none was associated with mesh complications. Limitation includes the retrospective design of the study. Robotic-assisted radical prostatectomy with simultaneous hernia repair and mesh placement is safe and does not increase complications related to the mesh. In our experience, hernia repair increases the operative time, usually due to initial peritoneal flap dissection and final suturing. Therefore, we believe that hernia repair with mesh during RARP is safe and spares patients the additional impacts of an additional surgical procedure.

En bloc resection of gastrobronchial fistula associated with mesh infection.

A 50-year-old woman presented with chief complaints of fever and cough. She had a poorly controlled left lung abscess and a history of congenital left diaphragmatic hernia treated 9 years prior with composite mesh. Computed tomography showed suspected fistula formation between the left lower lung lobe and stomach, and the tract was visualized in a contrast study from an upper gastrointestinal endoscope. We suspected a gastrobronchial fistula associated with mesh infection and performed en bloc resection of the mesh and inflamed organ tissue, comprising resection of the left lower lung lobe and left diaphragm, partial gastrectomy, and splenectomy. The diaphragm was reconstructed using the latissimus dorsi and rectus abdominis muscles. To our knowledge, this is the first report describing this treatment strategy for gastrobronchial fistula associated with mesh infection. The patient's postoperative course was favourable.

Choice of Polymer, but Not Mesh Structure Variation, Reduces the Risk of Bacterial Infection with Staphylococcus aureus In Vivo.

BACKGROUND: Synthetic mesh material is of great importance for surgical incisional hernia repair. The physical and biochemical characteristics of the mesh influence mechanical stability and the foreign body tissue reaction. The influence on bacterial infections, however, remains ill-defined. The aim of the present study was to evaluate the influence of a modified mesh structure with variation in filament linking on the occurrence of bacterial infection that is indicated by the occurrence of CD68+, CD4+, and CD8+ cells in two different materials. METHODS: A total of 56 male Sprague Dawley rats received a surgical mesh implant in a subcutaneous abdominal position. The mesh of two different polymers (polypropylene (PP) and polyvinylidenfluoride (PVDF)) and two different structures (standard structure and bold structure with higher filament linking) were compared. During the implantation, the meshes were infected with Staphylococcus (S.) aureus. After 7 and 21 days, meshes were explanted, and the early and late tissue responses to infection were histologically evaluated. RESULTS: Overall, the inflammatory tissue response was higher at 7 days when compared to 21 days. At 7 days, PP meshes of the standard structure (PP-S) showed the strongest inflammatory tissue response in comparison to all the other groups. At 21 days, no statistically significant difference between different meshes was detected. CD8+ cytotoxic T cells showed a significant difference at 21 days but not at 7 days. PP meshes of both structures showed a higher infiltration of CD8+ T cells than PVDF meshes. CD4+ T helper cells differed at 7 days but not at 21 days, and PVDF meshes in a bold structure showed the highest CD4+ T cell count. The number of CD68+ macrophages was also significantly higher in PP meshes in a standard structure when compared to PVDF meshes at 21 days. CONCLUSION: The inflammatory tissue response to S. aureus infection appears to be highest during the early period after mesh implantation. PP meshes showed a higher inflammatory response than PVDF meshes. The mesh material appears to be more important for the risk of infection than the variation in filament linking.

Difficult differential diagnosis of delayed mesh infection following inguinal hernia surgery involving appendiceal cancer: A case report.

INTRODUCTION: We present a case of post-inguinal hernia repair delayed mesh infection that was initially misdiagnosed as appendiceal cancer. PRESENTATION OF CASE: The patient was an 82-year-old man who underwent right inguinal hernia repair with a plug mesh 7 years before he presented with a lump in the right inguinal region. No skin infection signs were evident; blood tests revealed no inflammation or abnormal tumor markers. Abdominal contrast-enhanced computed tomography revealed a tumorous lesion in the right lower abdomen, raising the suspicion of appendiceal cancer with lymph node and lung metastases. Lower gastrointestinal endoscopy revealed extrinsic cecal wall compression. During laparoscopic ileocecal resection with lymph node dissection, a pus-filled abscess exposed the mesh in the inguinal region; hence, a diagnosis of a mesh infection was made. There were no macroscopic cancer signs in the appendix or cecum. Partial cecal resection involving the infected mesh was performed. Pathological tests did not reveal cancer, confirming the delayed mesh infection diagnosis. DISCUSSION: This case presents the diagnostic challenges posed by post-inguinal hernia repair delayed mesh infections, emphasizing the lack of typical clinical and imaging indications and the potential for misdiagnosis as appendiceal cancer. It also highlights the importance of early recognition and appropriate management of these infections. CONCLUSION: This case emphasizes the complexity of diagnosing post-inguinal hernia repair delayed mesh infections. These infections may mimic other conditions such as appendiceal cancer, stressing the need for vigilance and careful evaluation. Early recognition and proper management are essential to avoid unnecessary extensive surgeries.

Intestinal erosion caused by meshoma displacement: A case report.

BACKGROUND: A meshoma formation and erosion to the small intestine is rare. Herein, we report one case of a meshoma that was not treated early; causing it to displace and erode the small intestine, with infection, complete control of symptoms was achieved after removal of the infected patch mass, no recurrence of hernia after 2 years of follow-up. CASE SUMMARY: A 62-year-old male patient presented with recurrent abdominal pain repeatedly for 1 wk, which has worsened 2 d before admition, accompanied by fever. Five years before presentation he underwent right inguinal hernia Plug and patch repair approach. Two years ago, a computed tomography scan revealed a right lower abdominal mass with soft tissue density, measuring approximately 30 mm × 17 mm, which was diagnosed as meshoma that was not treated. The patient had poorly controlled diabetes in the past year. CONCLUSION: The formation of meshoma is rare, and that if not treated in time it might erode and require resection of the involved organ.

Microbiology of chronic mesh infection.

PURPOSE: Mesh infection following hernia repair is one of the most dreaded complications of hernia surgery. Mesh sinus, infected seromas, mesh extrusion, and mesh-related enteric fistulas are common complications associated with synthetic mesh. This study aimed to review the microbiota of mesh infection in 100 patients submitted to mesh explantation. METHODS: We reviewed the charts of patients presenting with a history of mesh infection lasting or arising six months or more after mesh placement. All patients who submitted to abdominal wall repair with complete removal of an infected mesh and presenting a positive culture were included. The microbiology analysis was based on positive cultures obtained from the fluids and tissues surrounding the mesh or positive cultures of the mesh. Microorganisms were divided into gram-positive or gram-negative, aerobic or anaerobic, and fungi. RESULTS: Pure aerobic gram-positive cultures were encountered in 50% of the patients, followed by a combination of aerobic gram-positive/gram-negative (8%) and pure gram-negative cultures (6%). Anaerobes were recovered from 31% of patients. Fungi were recovered from 6%. Staphylococcus aureus was identified in 64% of cultures, with methicillin-resistant Staphylococcus aureus present in 42% and methicillin-sensitive Staphylococcus aureus in 22%. Among aerobic gram-negative infections, six (17%) were caused by multi-resistant bacteria, including Pseudomonas aeruginosa, Proteus mirabilis, Acinetobacter baumanii, Klebsiella pneumoniae complex, and Enterobacter cloacae complex. CONCLUSION: Staphylococcus aureus plays a significant role in the pathogenesis of synthetic mesh infection. Staphylococcus aureus, isolated in 64% of cultures, accounted for most single bacterial infections and was the prevalent germ in mesh sinus and infected seromas. Gram-negative infection occurred in 35%. Anaerobes occurred in 31%, commonly encountered in polymicrobial infections. Most fungi cultures happened in patients with enteric fistulas.

Hernia Mesh Complications: Management of Mesh Infections and Enteroprosthetic Fistula.

The potential consequences of mesh infection mandate careful consideration of surgical approach, mesh selection, and preoperative patient optimization when planning for ventral hernia repair. Intraperitoneal mesh, microporous or laminar mesh, and multifilament mesh typically require explantation, whereas macroporous, monofilament mesh in an extraperitoneal position is often salvageable. Delayed presentation of mesh infection should raise the suspicion for enteroprosthetic fistula when intraperitoneal mesh is present. When mesh excision is necessary, the surgeon must carefully consider both the risk of recurrent infection as well as hernia recurrence when deciding on single-stage definitive reconstruction versus primary closure with delayed reconstruction.