Infections associated with prosthetic repairs of abdominal wall hernias: pathology, management and results              Tolino MJ*, Tripoloni DE, Ratto R, et al.*Department of Surgery, Sanatorio “Franchín”, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
Corresponding author: Tolino MJ,E-mail:marianotolino@yahoo.com.ar
Abstract    Objective    To analyse clinical and demographic factors of patients who suVered infection of the surgical site equiring mesh removal as a complication of prosthetic repairs, details of the hernioplasties in which meshes were implanted and their management and outcomes. Methods    Factors related to infection (demographic variables and characteristics of the repairs and mesh utilised) and the management before proceeding to mesh removal were obtained from patient charts. Collected specimens (meshes and tissues) from 32 consecutive patients were cultured and observed microscopically. The outcomes after mesh removal were prospectively evaluated.
Results    Twenty-two patients underwent incisional hernioplasties and ten inguinal hernioplasties; most of the procedures took a long time, and 28 patients presented early wound complications (seroma or haematoma). During the “implantation-removal” interval, some conservative treatments, such as drainages or sinus resection, were attempted under local anaesthesia. Twenty-two meshes were totally removed (nine after partial extraction); in the remaining ten cases partially removal was successful. Most of the meshes (24) were made of multiWlament polypropylene; microscopic observation of neighbouring tissues showed leucocyte inWltration, giant cell reaction, disorganisation of the collagen Wbres and abscedation. Treatment of 32 patients required 51 operations. Following mesh removal, there were six recurrences and two Wstulas of the bowel. The average follow-up was 40 months (30-97). Conclusion  Most of the infections requiring mesh removal were related to prolonged repair operations that presented untreated early postoperative wound complications. Partial extraction of meshes frequently leads to failures and complications. Surgical exploration should be performed under general anaesthesia to accomplish complete mesh extraction.