Surgical treatment of 128 cases of late-onset mesh infection after open inguinal tension-free hernia repair_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

HAN Wanlin ^1,2 , CUI Hang ¹ , ZHI Zhouhang ¹ ,  LI Xiaojun ¹

1. Department of General Surgery, Shaanxi Provincial People’s Hospital, Affiliated of Xi’an Medical University, Xi’an 710068, P. R. China;
2. Xi’an Medical University, Xi’an 710021, P. R. China;

Corresponding author：

LI Xiaojun, Email: Vanlin2020@163.com

Keywords：

inguinal hernia; tension-free repair; mesh infection; surgical treatment

DOI：

10.7507/1007-9424.202205072

Video：

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Objective To summarize the experience of surgical treatment of late-onset mesh infection after open inguinal hernia tension-free repair. Methods The retrospective descriptive study was conducted. The clinical data of 128 mesh infection patients after open inguinal tension-free hernia who were admitted to the Department of General Surgery of Shaanxi Provincial People’s Hospital form December 2016 to December 2021 were collected. All patients underwent debridement under general anesthesia through a treatment process of laparoscopic exploration, methylene blue staining, removal of mesh, wound irrigation, and negative pressure closed drainage. Patients were observed for completion of surgery, postoperative recovery, and follow-up results. Results One hundred and twenty-eight patients underwent open debridement successfully. In 98 patients, no abnormality was found on laparoscopic exploration and the infected meshs were removed by direct debridement surgery. In 28 patients, laparoscopic exploration revealed that the meshs had broken through the peritoneum and were tightly adherent to the mesentery and intestinal canal. In 2 patients, revealed abdominal abscesses at the paracolic sulcus of the ascending colon and at the ileocecal tract. The infected meshs were removed relatively intact in 112 patients, and the residual meshs were not removed intact in 16 patients. The operative time of 128 patients were 75–345 minutes with an average of 154 minutes, the bleeding volume was 10–200 mL with an average of 37.4 mL, the time to remove the negative pressure drainage tube after surgery were 5–14 days with an average of 8.4 days, the postoperative hospital stay were 6–18 days with an average of 11.6 days. There were 114 cases of class A healing, 12 cases of class B healing, and 2 cases of class C healing. One hundred and twenty-eight patients underwent postoperative follow-up for 6 to 60 months, with a media follow-up time of 30 months. During the follow-up period, 4 patients developed ipsilateral inguinal hernia recurrence, 4 patients developed reinfection, and 3 patients developed varying degrees of pain in the inguinal region. Conclusions Late-onset mesh infection after open inguinal tension-free hernia repair requires removal mesh by surgical treatment. Laparoscopic exploration, methylene blue-assisted debridement, complete removal of the mesh, strict wound irrigation and negative pressure closure drainage are safe and reliable treatment.

Citation： HAN Wanlin, CUI Hang, ZHI Zhouhang, LI Xiaojun. Surgical treatment of 128 cases of late-onset mesh infection after open inguinal tension-free hernia repair. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(11): 1488-1494. doi: 10.7507/1007-9424.202205072 Copy

1.	中华医学会外科学分会疝与腹壁外科学组, 中国医师协会外科医师分会疝和腹壁外科医师委员会. 成人腹股沟疝诊断和治疗指南(2018年版). 中国普通外科杂志, 2018, 27(7): 803-807.
2.	Chen T, Zhang YH, Wang HL, et al. Late-onset deep mesh infection: A study of eight cases detected from 2 666 consecutive patients with abdominal wall hernia repairs. Chin Med J (Engl), 2016, 129(15): 1870-1872.
3.	孙立, 申英末, 陈杰, 等. 腹股沟疝补片修补术后补片感染外科处理方法的研究. 中国普外基础与临床杂志, 2013, 20(12): 1341-1343.
4.	Ito H, Matsumoto K, Terauchi T, et al. Delayed mesh infection after inguinal hernia repair: a case report. J Surg Case Rep, 2021, 2021(9): rjab399. doi: 10.1093/jscr/rjab399.
5.	Jin C, Shen Y, Chen J. Laparoscopic evaluation and management of 47 patients with late-onset mesh infection after inguinal hernioplasty. Hernia, 2020, 24(2): 381-385.
6.	Chung L, Tse GH, O’Dwyer PJ. Outcome of patients with chronic mesh infection following abdominal wall hernia repair. Hernia, 2014, 18(5): 701-704.
7.	Tamura T, Ohata Y, Katsumoto F. Mesh removal and reconstruction with posterior components separation technique for delayed mesh infection developed 10 years after abdominal incisional hernia repair: a rare case report. J Surg Case Rep, 2019, 5(1): 140. doi: 10.1186/s40792-019-0697-3.
8.	Levy S, Moszkowicz D, Poghosyan T, et al. Comparison of complete versus partial mesh removal for the treatment of chronic mesh infection after abdominal wall hernia repair. Hernia, 2018, 22(5): 773-779.
9.	Simons MP, Aufenacker T, Bay-Nielsen M, et al. European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia, 2009, 13(4): 343-403.
10.	Kong W, Wang J, Mao Q, et al. Early- versus late-onset prosthetic mesh infection: more than time alone. Indian J Surg, 2015, 77(Suppl 3): 1154-1158.
11.	Johanet H, Contival N; Coelio Club. Mesh infection after inguinal hernia mesh repair. J Visc Surg, 2011, 148(5): e392-e394. doi: 10.1016/j.jviscsurg.2011.09.005.
12.	Yang H, Liu Y, Chen J, et al. The management of mesh infection after laparoscopic inguinal hernia repair. Surg Laparosc Endosc Percutan Tech, 2019, 29(1): 40-42.
13.	Colbran R, Nicol A, Ng J. Delayed mesh infection presenting as an abdominal mass after laparoscopic inguinal hernia repair. ANZ J Surg, 2020, 90(10): 2127-2129.
14.	Gossetti F, D’Amore L, Annesi E, et al. Mesh-related visceral complications following inguinal hernia repair: an emerging topic. Hernia, 2019, 23(4): 699-708.
15.	Pokala B, Armijo PR, Flores L, et al. Minimally invasive inguinal hernia repair is superior to open: a national database review. Hernia, 2019, 23(3): 593-599.
16.	Yang L, Wang H, Liang X, et al. Bacteria in hernia sac: an important risk fact for surgical site infection after incarcerated hernia repair. Hernia, 2015, 19(2): 279-283.
17.	Woo KY, Heil J. A prospective evaluation of methylene blue and gentian violet dressing for management of chronic wounds with local infection. Int Wound J, 2017, 14(6): 1029-1035.
18.	Heinrich SM, Sendi P, Clauss M. Methylene blue for the diagnosis of a sinus tract in periprosthetic knee joint infection. J Bone Jt Infect, 2021, 6(9): 423-424.
19.	Shaw JD, Miller S, Plourde A, et al. Methylene blue-guided debridement as an intraoperative adjunct for the surgical treatment of periprosthetic joint infection. J Arthroplasty, 2017, 32(12): 3718-3723.
20.	Wang D, Fu Y, Liu Q, et al. Maximal infected mesh removal with methylene blue injection for mesh infection after inguinal hernia repair. Surg Infect (Larchmt), 2021, 22(3): 347-352.
21.	Luo Y, Wang C. The clinical characteristics and treatment of mesh infection after laparoscopic inguinal hernia repair: Report of two cases and literature review. Asian J Surg, 2021, 44(11): 1449-1452.
22.	Kohno S, Hasegawa T, Aoki H, et al. Analysis of risk factors for surgical site infection and postoperative recurrence following inguinal and femoral hernia surgery in adults. Asian J Surg, 2022, 45(4): 1001-1006.
23.	Delikoukos S, Tzovaras G, Liakou P, et al. Late-onset deep mesh infection after inguinal hernia repair. Hernia, 2007, 11(1): 15-17.
24.	Fuziy RA, Artigiani Neto R, Caetano Junior EM, et al. Comparative study of four different types of intraperitoneal mesh prostheses in rats. Acta Cir Bras, 2019, 34(7): e201900703. doi: 10.1590/s0102-865020190070000003.
25.	Akyol C, Kocaay F, Orozakunov E, et al. Outcome of the patients with chronic mesh infection following open inguinal hernia repair. J Korean Surg Soc, 2013, 84(5): 287-291.
26.	Arnold MR, Kao AM, Otero J, et al. Mesh fistula after ventral hernia repair: What is the optimal management? Surgery, 2020 , 167(3): 590-597.
27.	Allegranzi B, Bischoff P, de Jonge S, et al. WHO Guidelines Development Group. New WHO recommendations on preoperative measures for surgical site infection prevention: an evidence-based global perspective. Lancet Infect Dis, 2016 , 16(12): e276-e287. doi: 10.1016/S1473-3099(16)30398-X.
28.	Jezupovs A. Minimally invasive mesh salvaging technique on treatment of hernia mesh infection: A case series. Int J Surg Case Rep, 2020, 70: 78-82.
29.	Li Y, Li PY, Sun SJ, et al. Chinese Trauma Surgeon Association for management guidelines of vacuum sealing drainage application in abdominal surgeries-Update and systematic review. Chin J Traumatol, 2019, 22(1): 1-11.
30.	Sanchez VM, Abi-Haidar YE, Itani KM. Mesh infection in ventral incisional hernia repair: incidence, contributing factors, and treatment. Surg Infect (Larchmt), 2011, 12(3): 205-210.

1. 中华医学会外科学分会疝与腹壁外科学组, 中国医师协会外科医师分会疝和腹壁外科医师委员会. 成人腹股沟疝诊断和治疗指南(2018年版). 中国普通外科杂志, 2018, 27(7): 803-807.
2. Chen T, Zhang YH, Wang HL, et al. Late-onset deep mesh infection: A study of eight cases detected from 2 666 consecutive patients with abdominal wall hernia repairs. Chin Med J (Engl), 2016, 129(15): 1870-1872.
3. 孙立, 申英末, 陈杰, 等. 腹股沟疝补片修补术后补片感染外科处理方法的研究. 中国普外基础与临床杂志, 2013, 20(12): 1341-1343.
4. Ito H, Matsumoto K, Terauchi T, et al. Delayed mesh infection after inguinal hernia repair: a case report. J Surg Case Rep, 2021, 2021(9): rjab399. doi: 10.1093/jscr/rjab399.
5. Jin C, Shen Y, Chen J. Laparoscopic evaluation and management of 47 patients with late-onset mesh infection after inguinal hernioplasty. Hernia, 2020, 24(2): 381-385.
6. Chung L, Tse GH, O’Dwyer PJ. Outcome of patients with chronic mesh infection following abdominal wall hernia repair. Hernia, 2014, 18(5): 701-704.
7. Tamura T, Ohata Y, Katsumoto F. Mesh removal and reconstruction with posterior components separation technique for delayed mesh infection developed 10 years after abdominal incisional hernia repair: a rare case report. J Surg Case Rep, 2019, 5(1): 140. doi: 10.1186/s40792-019-0697-3.
8. Levy S, Moszkowicz D, Poghosyan T, et al. Comparison of complete versus partial mesh removal for the treatment of chronic mesh infection after abdominal wall hernia repair. Hernia, 2018, 22(5): 773-779.
9. Simons MP, Aufenacker T, Bay-Nielsen M, et al. European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia, 2009, 13(4): 343-403.
10. Kong W, Wang J, Mao Q, et al. Early- versus late-onset prosthetic mesh infection: more than time alone. Indian J Surg, 2015, 77(Suppl 3): 1154-1158.
11. Johanet H, Contival N; Coelio Club. Mesh infection after inguinal hernia mesh repair. J Visc Surg, 2011, 148(5): e392-e394. doi: 10.1016/j.jviscsurg.2011.09.005.
12. Yang H, Liu Y, Chen J, et al. The management of mesh infection after laparoscopic inguinal hernia repair. Surg Laparosc Endosc Percutan Tech, 2019, 29(1): 40-42.
13. Colbran R, Nicol A, Ng J. Delayed mesh infection presenting as an abdominal mass after laparoscopic inguinal hernia repair. ANZ J Surg, 2020, 90(10): 2127-2129.
14. Gossetti F, D’Amore L, Annesi E, et al. Mesh-related visceral complications following inguinal hernia repair: an emerging topic. Hernia, 2019, 23(4): 699-708.
15. Pokala B, Armijo PR, Flores L, et al. Minimally invasive inguinal hernia repair is superior to open: a national database review. Hernia, 2019, 23(3): 593-599.
16. Yang L, Wang H, Liang X, et al. Bacteria in hernia sac: an important risk fact for surgical site infection after incarcerated hernia repair. Hernia, 2015, 19(2): 279-283.
17. Woo KY, Heil J. A prospective evaluation of methylene blue and gentian violet dressing for management of chronic wounds with local infection. Int Wound J, 2017, 14(6): 1029-1035.
18. Heinrich SM, Sendi P, Clauss M. Methylene blue for the diagnosis of a sinus tract in periprosthetic knee joint infection. J Bone Jt Infect, 2021, 6(9): 423-424.
19. Shaw JD, Miller S, Plourde A, et al. Methylene blue-guided debridement as an intraoperative adjunct for the surgical treatment of periprosthetic joint infection. J Arthroplasty, 2017, 32(12): 3718-3723.
20. Wang D, Fu Y, Liu Q, et al. Maximal infected mesh removal with methylene blue injection for mesh infection after inguinal hernia repair. Surg Infect (Larchmt), 2021, 22(3): 347-352.
21. Luo Y, Wang C. The clinical characteristics and treatment of mesh infection after laparoscopic inguinal hernia repair: Report of two cases and literature review. Asian J Surg, 2021, 44(11): 1449-1452.
22. Kohno S, Hasegawa T, Aoki H, et al. Analysis of risk factors for surgical site infection and postoperative recurrence following inguinal and femoral hernia surgery in adults. Asian J Surg, 2022, 45(4): 1001-1006.
23. Delikoukos S, Tzovaras G, Liakou P, et al. Late-onset deep mesh infection after inguinal hernia repair. Hernia, 2007, 11(1): 15-17.
24. Fuziy RA, Artigiani Neto R, Caetano Junior EM, et al. Comparative study of four different types of intraperitoneal mesh prostheses in rats. Acta Cir Bras, 2019, 34(7): e201900703. doi: 10.1590/s0102-865020190070000003.
25. Akyol C, Kocaay F, Orozakunov E, et al. Outcome of the patients with chronic mesh infection following open inguinal hernia repair. J Korean Surg Soc, 2013, 84(5): 287-291.
26. Arnold MR, Kao AM, Otero J, et al. Mesh fistula after ventral hernia repair: What is the optimal management? Surgery, 2020 , 167(3): 590-597.
27. Allegranzi B, Bischoff P, de Jonge S, et al. WHO Guidelines Development Group. New WHO recommendations on preoperative measures for surgical site infection prevention: an evidence-based global perspective. Lancet Infect Dis, 2016 , 16(12): e276-e287. doi: 10.1016/S1473-3099(16)30398-X.
28. Jezupovs A. Minimally invasive mesh salvaging technique on treatment of hernia mesh infection: A case series. Int J Surg Case Rep, 2020, 70: 78-82.
29. Li Y, Li PY, Sun SJ, et al. Chinese Trauma Surgeon Association for management guidelines of vacuum sealing drainage application in abdominal surgeries-Update and systematic review. Chin J Traumatol, 2019, 22(1): 1-11.
30. Sanchez VM, Abi-Haidar YE, Itani KM. Mesh infection in ventral incisional hernia repair: incidence, contributing factors, and treatment. Surg Infect (Larchmt), 2011, 12(3): 205-210.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Surgical treatment of 128 cases of late-onset mesh infection after open inguinal tension-free hernia repair

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