13 Cases Report Of Prosthetic Mesh Infection After External Abdominal Hernia Repair And Literature Review

Background:External abdominal hernia,which is one of common diseases in general surgery department,includes inguinal hernia?femoral hernia?incisional hernia?umbilical hernia and so on.Among all of these,inguinal hernia has the highest morbidity,taking up 90%-95%of external abdominal hernia.Once the disease occurs,it cann't be cured unless surgical treatment.But traditional operation methods need suture under tension which will cause postoperative pain and high recurrence rates.Since the the concept of tension free hernioplasty was put forward,the prognosis for external abdominal hernia has been greatly improved.And prosthetic mesh has also widely used in clinical practice.But some more problems associated with prosthetic mesh(such as mesh infection?seroma?intestinal adhesion)have come in picture.Mesh infection which is very hard to treat often lead to the failure of surgical treatment,and it's one of severe postoperative complications after tension free hernioplasty.The cause?risking factors and prevention of mesh infection may not be fully understood,and there isn't a widely recognized standard in the diagnose of mesh infection yet.Objective:By analyzing the clinical data about the patients who suffer from mesh infection and reviewing the related literatures,to summarize the risking factors?clinical manifestations and management of mesh infection,in order to provide clinical experience to control mesh infection.Methods:A retrospective analysis was conducted on clinical data of 13 patients who accepted management of mesh infection after external abdominal hernia repair in Qilu Hospital form November 2013 to March 2017.Collect and analyze the clinical data about the patients,including basic information?medical history?laboratory testing?treatment plan?follow-up and so on.Results:13 patients were chosen in this study,including 10 males and 3 females.The average age is 46.5±15.2,which ranges from 20 to 68.The average BMI is 26.1±4.4kg/m2.Included were 9 cases of mesh infection after inguinal hernia repair and 4 cases of mesh infection after incisional hernia repair.About clinical features,2 patients appeared postoperative fever(T>38?),1 patients appeared the erythema overlying incision,6 patients appeared the pain of initial incision,and 12 patients were found sinus and pus at the initial incision.The median of disease duration is 6 months,which ranges from 41 days to 2 years.All patients were treated with local dressing changes by the primary operative surgeon or Qilu Hospital for 41 days to 2 years,but their wounds did not heal.Finally,these patients accepted radical removal of the infected mesh.One patient had incision infection postoperatively,and achieved secondary healing after local dressing changes.Patients were followed up for 4-36 months with a median of 23 months.No patient had ventral hernia relapse.Conclusion:1.Some factors about patients?open operation?emergency surgery and superficial infection in initial incision may increase the risk of mesh infection.2.Mesh infection has a chronic course,which can present as the pain of initial incision?erythema overlying incision?sinus and pus at the initial incision,also can present systemic symptoms such as fever.3.The diagnose of mesh infection mainly depend on patients' medical history and clinical manifestations.Laboratory testing and imaging tests can indicate the diagnose.4.Treatment of mesh infection should accord to the individual clinical condition.If patients can get cured with conservative treatment for a long time,removal of the infected mesh should be taken in time.