Infected mesh: incidence and non conservative treatment

Abstract

Background: due to good results, polypropylene mesh was used since the 90’.Publications dealing with mesh infection have been scarce, motivating controversy on the management of this complication.
Objective: to point out the incidence and the non conservative treatment complexity of infected mesh.
Application: public hospital.
Design: retrospective observational studies.
Population: From January 2005 to December 2012, 411 patients with abdominal wall defects were operated on with the use of prosthetic mesh. Of them, 6 became infected and comprise the subject of this presentation.
Method: 2 groups were considered: Group A , 400 cm² prosthesis, 71 patients (17.3%) and Group B, mesh between 40 cm² and 70 cm²,340 patients (82.75%). Time of onset of infection, bacterial agent involved, host-mesh interphase, comorbidities and treatment were assessed.
Results: 4 patients became infected in Group A (5.6%), and 2 patients in group B (0.6%). Chronic fistula with continuous purulent discharge after 20 months was the reason for consultation in patients with large mesh. Stafhylococcus aureus was the most common bacterial agent, and Koch’s bacillus was isolated at the host-mesh interphase of one patient who had a hernia repair surgery.Since conservative treatment was infructuous in Group A, infected mesh were removed by early, interative and complex
surgical procedures. Hospitalization exceeded 10 days and lost work days 3 months. 
Conclusion: large prosthesis must be removed in most cases, when presented with chronic infection and purulent fistulae.