Management of Infected Mesh After Abdominal Hernia Repair: Systematic Review and Single-Institution Experience.
Ann Plast Surg
; 80(2): 145-153, 2018 Feb.
Article
em En
| MEDLINE
| ID: mdl-28671890
ABSTRACT
BACKGROUND:
Mesh infection after abdominal hernia repair is a devastating complication that affects general and plastic surgeons alike. The purpose of this study was 3-fold (1) to determine current evidence for treatment of infected abdominal wall mesh via systematic review of literature, (2) to analyze our single-institution experience with treatment of infected mesh patients, and (3) to establish a framework for how to approach this complex clinical problem.METHODS:
Literature search was performed using the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines, followed by single-institution retrospective analysis of infected mesh patients.RESULTS:
A total of 3565 abstracts and 92 full-text articles were reviewed. For qualitative and quantitative assessment, articles were subdivided on the basis of treatmentapproach:
"conservative management," "excision of mesh with primary closure," "single-stage reconstruction," "immediate staged repair," and "repair in contaminated field." Evidence for each treatment approach is presented. At our institution, most patients (40/43) were treated by excision of infected mesh and single-stage reconstruction with biologic mesh. When the mesh was placed in a retrorectus or underlay fashion, 21.4% rate of hernia recurrence was achieved. Bridged repairs were highly prone to recurrence (88.9%; P = 0.001), but the bridging biologic mesh seemed to maintain domain and potentially contribute to a more effective repair in the future. Of the patients who underwent additional ("secondary") repairs after recurrence, 75% were eventually able to achieve "hernia-free" state.CONCLUSIONS:
This study reviews the literature and our single-institution experience regarding treatment of infected abdominal wall mesh. Framework is developed for how to approach this complex clinical problem.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Infecções por Pseudomonas
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Infecções Estafilocócicas
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Telas Cirúrgicas
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Infecção da Ferida Cirúrgica
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Hérnia Abdominal
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Herniorrafia
Tipo de estudo:
Diagnostic_studies
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Etiology_studies
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Guideline
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Observational_studies
/
Prognostic_studies
/
Qualitative_research
/
Systematic_reviews
Limite:
Adult
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Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Ann Plast Surg
Ano de publicação:
2018
Tipo de documento:
Article