The Demographics of Mesh Infections

Authors:
Coleman Miller, Edwin George Mathew, Thomas Clements, Julie Holihan, Dalya Ferguson, Jonah Stulberg

Body of Abstract:
Background

The American College of Surgeons estimates that more than 600,000 ventral hernia repairs are performed in the US annually. Estimates suggest that between 2% and 10% of ventral hernia repairs result in a surgical site infection with rates based on patient factors such as body mass index, diabetes, active smoking and immunosuppression. Surgical factors such as an open versus a minimally invasive approach, influence the risk of developing a surgical site infection, and there is data to suggest that mesh location and the type of mesh used effect the ability to clear an infection with antibiotics. However, very little is known about patients who develop chronic mesh infections that require surgical intervention. This lack of data inhibits our ability to prevent this devastating problem. The goal of this study is to describe patient and mesh characteristics associated with the development of a mesh infection requiring surgical removal.

Methods

We conducted a case series analysis utilizing our institution’s hernia quality registry that capture 100% of the hernia repairs performed in our hernia center since August of 2021. Once a subset of cases referred to us for management of a chronic mesh infection were identified, we utilized chart review to investigate patient, hernia and mesh characteristics relevant to development of and management of a chronic mesh infection.

Results

Of the 662 patients in our database that have undergone ventral hernia repair, 17 (2.6%) of them were referred to us with a chronic mesh infection. The median age of these patients was 61 years (IQR 17) and median BMI was 36 (IQR 8.6).Nine (53%) were male, seven (41%) were diabetic and four (24%) were active smokers. In 14 (76%) patients, infected mesh was found to be in the underlay location, two (12%) patients had infected mesh in the onlay position, and one (6%) infected mesh was in the retro-rectus position. Eight (47%) patients had an enterocutaneous fistula to their infected mesh.

Conclusion

Chronic mesh infection after ventral hernia repair is a rare complication that is likely multifactorial. There is minimal quality data regarding those who develop chronic mesh infection. Further studies are needed to assess the relationship between these variables and the development of mesh infections.