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Definitive Surgical Treatment of Infected or Exposed Ventral Hernia Mesh

Szczerba, Steven R. MD*; Dumanian, Gregory A. MD†

Original Articles

Objective: To discuss the difficulties in dealing with infected or exposed ventral hernia mesh, and to illustrate one solution using an autogenous abdominal wall reconstruction technique.

Summary Background Data: The definitive treatment for any infected prosthetic material in the body is removal and substitution. When ventral hernia mesh becomes exposed or infected, its removal requires a solution to prevent a subsequent hernia or evisceration.

Methods: Eleven patients with ventral hernia mesh that was exposed, nonincorporated, with chronic drainage, or associated with a spontaneous enterocutaneous fistula were referred by their initial surgeons after failed local wound care for definitive management. The patients were treated with radical en bloc excision of mesh and scarred fascia followed by immediate abdominal wall reconstruction using bilateral sliding rectus abdominis myofascial advancement flaps.

Results: Four of the 11 patients treated for infected mesh additionally required a bowel resection. Transverse defect size ranged from 8 to 18 cm (average 13 cm). Average procedure duration was 3 hours without bowel repair and 5 hours with bowel repair. Postoperative length of stay was 5 to 7 days without bowel repair and 7 to 9 days with bowel repair. Complications included hernia recurrence in one case and stitch abscesses in two cases. Follow-up ranges from 6 to 54 months (average 24 months).

Conclusions: Removal of infected mesh and autogenous flap reconstruction is a safe, reliable, and one-step surgical solution to the problem of infected abdominal wall mesh.

Prosthetic mesh is widely used in the repair of midline ventral hernias. Mesh ventral hernia repairs have lower hernia recurrence rates than do primary repairs. 1 This lower hernia recurrence rate comes at the price of mesh-related complications such as infection, extrusion, and enterocutaneous fistula formation. 2,3

The treatment of infected mesh is a difficult surgical challenge. Removal of the infected mesh is the clearest manner of dealing with the problem. Avoidance of postoperative evisceration and maintenance of a competent abdominal wall are secondary and important goals of treatment of patients with infected mesh.

Rectus abdominis myofascial flap closure of the large midline defect after mesh excision is one potential surgical solution. This procedure, also known as the “separation of parts” hernia repair, has been reported as having low hernia recurrence rates. 4–10 Despite low reported hernia recurrence rates, this procedure does not seem to be frequently or widely used in ventral hernia repair. We reviewed our consecutive series of 11 patients who presented for management of infected mesh after a previous midline ventral hernia repair to illustrate one possible solution to this difficult surgical complication.

From the Departments of Surgery and the Divisions of Plastic Surgery, *Emory University, Atlanta, Georgia, and †Northwestern University, Chicago, Illinois

Correspondence: Dr. Gregory A. Dumanian, Division of Plastic Surgery, 675 N. St. Clair, Suite 19-250, Chicago, IL 60611.

E-mail: gdumania@nmh.org

Accepted for publication August 5, 2002.

© 2003 Lippincott Williams & Wilkins, Inc.