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

Infection-Resistant Polypropylene Hernia Mesh: Vision & Innovations

The surgical repair of hernias, a prevalent condition affecting millions worldwide, has traditionally relied on polypropylene (PP) mesh due to its favorable mechanical properties and biocompatibility. However, postoperative infections remain a significant complication, underscoring the need for the development of infection-resistant hernia meshes. This study provides a comprehensive analysis of current advancements and innovative strategies aimed at enhancing the infection resistance of PP mesh. It presents an overview of various research efforts focused on the integration of antimicrobial agents, surface modifications, and the development of bioactive coatings to prevent bacterial colonization and biofilm formation. Additionally, the synergistic effects of novel material designs and the role of nanotechnology in optimizing the anti-infective properties of PP mesh are explored. Recent clinical outcomes and in vitro studies are critically examined, highlighting challenges and potential future directions in the development of next-generation hernia meshes. Emphasis is placed on the importance of interdisciplinary approaches in advancing surgical materials with the ultimate goal of improving patient outcomes in hernia repair.

Early Removal of the Abdominal Patch is Superior to Late Removal in Children With Congenital Diaphragmatic Hernia

INTRODUCTION

Open repair of Congenital diaphragmatic hernia (CDH) in neonates often involves reconstruction of the abdominal wall using a patch. Data on predictors for the need of a patch and associated postoperative risks, such as infection or patch detachment, are limited. Specifically, the question regarding the ideal timepoint of patch removal remains unanswered.

METHODS

Data from 1000 neonatal CDH cases at the University Clinic Mannheim (2000-2022) were analyzed in this longitudinal, prospective cohort study. The study identified predictors for the requirement of an abdominal wall patch, quantified the surgical duration attributable to their use, determined outcome variables and investigated the incidence of infection and the spectrum of associated pathogens.

RESULTS

152 patients received an abdominal wall patch (GORE-TEX®). Predictive factors included birth weight, gestational age, gender, time of diagnosis of CDH, defect size, type of hernia, and liver-up. The majority of all patches which had to be explanted, was removed within one year, resulting in shorter operation time (median: 99.5 min) compared to late removal (>365 days, median: 144.5 min, p < 0.0163). Complication rates were comparable in both groups (early: 26.87 %, late: 25.93 %, p = 0.9257). Most common reasons for patch removal were: infections (50.00 %), elective removal (28.72 %) and removal concomitantly during another surgery (13.83 %). The most common pathogen in infected patches was Staphylococcus aureus.

CONCLUSION

The study suggests that early patch removal is associated with a shorter surgery time and does not lead to an increased rate of complications. In cases of patch infection, empirical antibiotic therapy targeting staphylococcal bacteria is recommended in the absence of an antibiogram. It may provide pediatricians and pediatric surgeons with guidance regarding the postoperative management of abdominal wall patches.

The Unfulfilled Potential of Synthetic and Biological Hydrogel Membranes in the Treatment of Abdominal Hernias

Hydrogel membranes can offer a cutting-edge solution for abdominal hernia treatment. By combining favorable mechanical parameters, tissue integration, and the potential for targeted drug delivery, hydrogels are a promising alternative therapeutic option. The current review examines the application of hydrogel materials composed of synthetic and biological polymers, such as polyethylene glycol (PEG), polyvinyl alcohol (PVA), gelatine, and silk fibroin, in the context of hernia repair. Overall, this review highlights the current issues and prospects of hydrogel membranes as viable alternatives to the conventional hernia meshes. The emphasis is placed on the applicability of these hydrogels as components of bilayer systems and standalone materials. According to our research, hydrogel membranes exhibit several advantageous features relevant to hernia repair, such as a controlled inflammatory reaction, tissue integration, anti-adhesive-, and even thermoresponsive properties. Nevertheless, despite significant advancements in material science, the potential of hydrogel membranes seems neglected. Bilayer constructs have not transitioned to clinical trials, whereas standalone membranes seem unreliable due to the lack of comprehensive mechanical characterization and long-term in vivo experiments.

Non-mesh inguinal hernia repair with early resumption of peritoneal dialysis in patients on continuous ambulatory peritoneal dialysis

PURPOSE

Inguinal hernia is a common complication of peritoneal dialysis (PD). Although tension-free mesh repair is a leading option for inguinal hernia repair, concerns over serious mesh-related complications may indicate a role for non-mesh inguinal hernia repair. In addition, there is no consensus on the perioperative dialysis regimen. Early resumption of PD may avoid the additional risks associated with hemodialysis. We report on the outcomes of non-mesh inguinal hernia repair in patients on continuous ambulatory PD (CAPD) and provide a perioperative dialysis protocol that aims to guide early resumption of PD.

METHODS

Between May 2019 and September 2023, thirty CAPD patients with 43 inguinal hernias who underwent non-mesh inguinal hernia repair were retrospectively analyzed. Data on the patient characteristics, perioperative dialysis regimen, perioperative features, complications, and hernia recurrence were collected and assessed.

RESULTS

Thirty patients with a total of 43 inguinal hernia repairs were included in this study. The median age was 53 years. 23 patients were male and 7 were female. Non-mesh inguinal repair was performed for all patients. PD was resumed at a median of 2 days after the surgery. Five patients received interim hemodialysis. There were no postoperative surgical or uremic complications and no recurrence after a median follow-up of 31.5 months.

CONCLUSION

Our study demonstrates the effectiveness and safety of non-mesh repair with early resumption of PD in patients on CAPD. Interim HD is unnecessary in selected patients. Choosing the optimal perioperative dialysis regimen is essential to managing inguinal hernias in CAPD patients.

The Effects of Pectin-Honey Hydrogel in a Contaminated Chronic Hernia Model in Rats

Incisional hernia is a frequent complication after abdominal surgery. A previous study on rats evaluated the use of a Pectin-Honey Hydrogel (PHH)-coated polypropylene (PP) mesh for the healing of acute hernias. However, there are no studies investigating the use of PHH in association with PP mesh in chronic contaminated hernia. The aims of this study are to assess the effectiveness of PHH in promoting abdominal hernia repaired with PP mesh and in counteracting infection. Twenty Sprague Dawley male rats were enrolled and a full thickness defect was made in the abdominal wall. The defect was repaired after 28 days using a PP mesh, and a culture medium (Tryptone Soy Broth, Oxoid) was spread onto the mesh to contaminate wounds in both groups. The rats were randomly assigned to a treated or untreated group. In the treated group, a PHH was applied on the mesh before skin closure. At euthanasia-14 days after surgery-macroscopical, microbiological and histopathological evaluations were performed, with a score attributed for signs of inflammation. An immunohistochemical investigation against COX-2 was also performed. Adhesions were more severe (p = 0.0014) and extended (p = 0.0021) in the untreated group. Bacteriological results were not significantly different between groups. Both groups showed moderate to severe values (score > 2) in terms of reparative and inflammatory reactions at histopathological levels. The use of PHH in association with PP mesh could reduce adhesion formation, extension and severity compared to PP mesh alone. No differences in terms of wound healing, contamination and grade of inflammation were reported between groups.

Testicular necrosis and subsequent orchiectomy as a complication of inguinal mesh infection surgery: a case report

The management of inguinal hernias has been revolutionised with mesh-based techniques, which are now the gold standard. In rare cases, complications can occur, the most common being prosthesis infection. The course is unpredictable, causing considerable morbidity and multiple interventions in the case of chronicity. We treated a 38-year-old patient for an inguinal mesh infection that evolved for 8 years before definitive management. The peculiarity of this finding is the occurrence of testicular necrosis following complete removal of the prosthesis, which is likely to be related to spermatic vessel injuries. This observation shows that although healing is achieved, there may be significant sequelae, and infection prevention must be a constant concern while inserting a mesh.