Laparoscopic evaluation and management of 47 patients with late-onset mesh infection after inguinal hernioplasty

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.

Hernia mesh infection treatment following the repair of abdominal wall hernias: A single-center experience

INTRODUCTION

The mesh-based repair of abdominal wall hernias is a commonly employed approach as it is easy to implement and associated with low rates of hernia recurrence. However, the occurrence of hernia mesh infections following such repair can be extremely serious, and no clinical consensus regarding the optimal treatment of such infections has been established. This study was thus developed to review the management of hernia mesh infection cases treated at our center, summarizing the demographic and clinical characteristics of affected patients and summarizing our associated therapeutic experiences.

METHODS

Data pertaining to 64 cases of hernia mesh infections treated at our center were retrospectively reviewed. Data were obtained from patient medical records, including general situation, hernia type, prior hernia repair approaches, type of mesh, and postoperative condition. Other reviewed outcomes include bacteriological and imaging findings, as well as treatment outcomes. In cases where conservative management was not successful, the approach to mesh removal (laparoscopic vs. open) was made based on the primary surgical approach and the type of material used for the repair.

RESULTS

In total, 42 patients underwent primary open inguinal hernioplasty (including plug repair, preperitoneal mesh repair, and Lichtenstein repair), while 11 patients underwent laparoscopic repair (9 transabdominal preperitoneal, TAPP and 2 totally extraperitoneal,TEP), and 11 patients with incisional hernias underwent the intraperitoneal onlay mesh (IPOM) procedure. Six patients exhibited mesh erosion of the internal organs. Of these patients, 38 underwent mesh removal via open debridement, while 9 underwent laparoscopic exploration and open debridement, and 1 underwent laparoscopic mesh removal. No patients exhibited serious postoperative sequelae, serious complications, or mortality after the treatment of mesh infections.One patient experienced postoperative infection recurrence following partial mesh removal, with the appearance of a small fistula. Hernias recurred in 2 patients following mesh removal, and 1 patient underwent repair via laparoscopic IPOM.

CONCLUSIONS

While conservative treatment can cure early mesh infections, there is nonetheless a risk that these infections will recur. In view of the variety of surgical intervention of abdominal wall hernias at present,treatment of mesh infection should be individualized. Our findings suggest that hernias repaired via the placement of mesh in the preperitoneal space can more readily contribute to internal organ erosion and late-onset infections, with open debridement often being unable to completely remove the mesh without causing collateral damage. Laparoscopic exploration is an effective and minimally invasive approach to detecting internal organ involvement and removing the infected hernia mesh from affected patients.

What is the outcome of late-onset infected mesh removal after open tension-free inguinal hernioplasty: 3-year follow-up

PURPOSE

Reports of mesh infections following open tension-free inguinal hernioplasty are gradually increasing. Recent research has focused on identifying and managing mesh infections. However, studies examining the long-term outcomes and quality of life following mesh removal for late-onset infections are few. This study aimed to analyze the short and long-term outcomes after maximal removal of the implanted mesh in patients with late-onset mesh infection after open tension-free inguinal hernioplasty.

METHODS

Data of 105 patients who developed late-onset mesh infection after open tension-free inguinal hernioplasty and were admitted to our hospital from January 2014 to January 2019 were retrospectively analyzed. Patients were followed up by telephone or outpatient consultation for 3 years, focusing on hernia recurrence and mesh infection recurrence. Quality of life was assessed preoperatively and postoperatively using our developed scale; postoperative inguinal area pain was assessed using the visual analog score, and postoperative anxiety was assessed using the anxiety self-assessment scale.

RESULTS

Of the 105 patients who experienced late-onset mesh infection following open inguinal hernioplasty, 100 underwent mesh plug repair. The mean follow-up time was 58 months, and 10.5% (95/105) of the patients were lost to follow-up. Recurrence of infection was observed in 28.6% of patients (2/7) who underwent partial mesh removal and in 3.4% of patients (3/88) who underwent complete mesh removal. One inguinal hernia recurred 12 months after mesh removal (1.0% recurrence rate). In the third year following surgery as compared to the preoperative period, there were significant improvements in quality of life.

CONCLUSIONS

Hernia plugs may not be a good choice in tension-free inguinal hernia repair in view of the risk of late infections and fistulas. Remove all mesh at the time of the first operation for mesh infection. Hernia recurrence after late-onset infected mesh removal following open inguinal tension-free hernioplasty is rare. The post-operative quality of life, pain, and anxiety are gradually steadily improving.

Discitis due to late-onset mesh infection 14 years after inguinal hernia repair: a case report

BACKGROUND

Mesh infection after inguinal hernia repair is a very rare complication. The incidence of late-onset mesh infection is approximately 0.1-0.2% of total hernia repair cases and can lead to serious complications if not treated promptly. Here, we report a rare case of discitis due to late-onset mesh infection, occurring 14 years after an inguinal hernia repair.

CASE PRESENTATION

An 89-year-old man was brought to our hospital with right-sided abdominal pain and signs of hypoglycemia. He had a history of type 2 diabetes mellitus and had undergone inguinal hernia repair 14 years ago. Upon admission, laboratory tests revealed no elevated inflammatory markers. Computed tomography (CT) revealed a peri-appendicular abscess. Although the patient was administered empiric antibiotics, on day 3 of admission, his white blood cell count and C-reactive protein levels increased to 38,000/µl and 28 mg/dl, respectively. CT-guided drainage was attempted but was not successful. Escherichia coli was detected in both blood culture collections. On day 7 of admission, the patient complained of back pain; CT on day 10 revealed a peri-appendicular abscess with a soft tissue shadow anterior to the thoracic vertebrae at the 8th/9th level. Thoracic discitis, due to bacteremia originating from the mesh abscess, was suspected. We surgically resected the appendix, followed by removal of the plug and mesh abscess. The post-operative course of the patient was uneventful. For treating discitis, it is known that antibiotic therapy is required for a minimum of 6 weeks. Therefore, on the 30th day post-surgery, the patient was transferred to the orthopedic ward for continued treatment.

CONCLUSIONS

This report discusses a rare case of late-onset mesh infection leading to thoracic discitis. Since late-onset mesh infection cannot be treated solely with antibiotics, expeditious surgery should be selected when subcutaneous drainage fails. When an immunocompromised patient with bacteremia has a complaint of back pain, purulent spinal discitis should also be suspected.

Late-Onset Ileocutaneous Fistula Eight Years After Plug Repair With Polypropylene Mesh: A Case Report

Introduction: As one of the short-term complications after inguinal hernia repair, mesh infection frequently occurs but rarely leads to ileocutaneous fistula. We present a rare case of ileocutaneous fistula 8 years after inguinal hernia plug repair with polypropylene mesh.

Case Presentation: The patient was a 67-year-old male who underwent a plug repair with polypropylene mesh of the right inguinal hernia. Eight years after the primary repair, skin ulceration with pus presented in the right groin area, and the final diagnosis was enterocutaneous fistula. According to laparoscopic exploration, the ileum below the fistula closely adhered to the abdominal wall. After gently separating the bowel loop, a defect area of about 2 × 3 cm was observed on the surface of the ileum. In laparotomy, the plug was found embedded in the ileum and then was completely removed, and an ileum side-to-side anastomosis was performed. The patient was discharged 2 weeks after the surgery, and follow-up at the sixth month revealed complete healing of the wound and no evidence of hernia recurrence.

Conclusion: Late-onset ileocutaneous fistula should be considered in the differential diagnosis in patients who present inflammation and abscess formation after hernia repair. Besides, for patients with suspected intestinal fistula after hernia repair, laparoscopic exploration should be given priority, and the mesh removal approach should be tailored according to the results of laparoscopic exploration.

Prevention of intestinal adhesion and regeneration of abdominal wall tissue with meshes containing an electrostatically spun acellular dermal matrix (ADM)/silk fibroin (SF) fiber composite polypropylene mesh

The repair of abdominal wall defects often requires the use of polypropylene (PP) as the main material. After a PP mesh is implanted in the body, contact with the intestine can cause adhesions between the intestine and the mesh, leading to serious complications such as intestinal fistula. In this study, we used electrostatic spinning technology to coat one side of PP meshes with an electrostatically spun isolating layer of acellular dermal matrix (ADM)/silk fibroin (SF) hybrid material. These meshes were used to repair abdominal wall defects in model rats and were compared with polycaprolactone (PCL) composite polypropylene meshes and PP meshes. The results showed that the adhesion score and area of ADM/SF-PP meshes were smaller than those of PCL-PP and PP meshes. Immunohistochemical assessment revealed that the ADM/SF meshes could effectively reduce the inflammatory response at the contact surface between the meshes and abdominal organs. The tissues regenerated on the abdominal side were rich in new blood vessels. Furthermore, the ADM/SF meshes could effectively reduce the expression levels of the inflammation-related factors IL-6 and TNF-α. The expression levels of tissue regeneration-related factors, such as VEGF and PAX-7, were also higher after ADM/SF-PP mesh-mediated repair than after PCL-PP mesh and PP mesh repair. Thus, ADM/SF-PP meshes can effectively reduce the inflammatory response at the contact surface between the meshes and abdominal organs and quickly promote regeneration of abdominal surface tissue to prevent and reduce abdominal adhesion and support restoration of the abdominal wall.