Trunzo J A, Ponsky J L, Jin J, Williams C P, Rosen M J
Department of Surgery, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Lakeside Building 7th Floor, Cleveland, OH 44106, USA.
Hernia. 2009 Oct;13(5):545-9. doi: 10.1007/s10029-009-0470-9. Epub 2009 Feb 12.
Salvaging infected prosthetic material after ventral hernia repair is rarely successful. Most cases require mesh excision and complex abdominal wall reconstruction, with variable success rates. We report two cases of mesh salvage with a novel use of percutaneous drainage and antibiotic irrigation.
Two patients developed infected seromas after laparoscopic ventral hernia repair. One patient with a remote history of methicillin-resistant Staphylococcus aureus (MRSA) mesh infection underwent laparoscopic ventral hernia repair with a 20 x 23-cm piece of Parietex composite mesh. Two weeks post-operatively, he developed fevers and MRSA was aspirated from the seroma. Another patient had a 32 x 33-cm piece of ePTFE placed for repair. He subsequently developed a massive seroma requiring repeated aspirations. Four months following the repair, he developed an infected seroma with Klebsiella pneumonia. Each patient underwent percutaneous drainage of their abscesses with a six-French-pigtail catheter under ultrasound guidance. After 2 weeks of parenteral antibiotics and clinical resolution, the patients were placed on 4 weeks of gentamicin irrigations (80 mg in 30 cc solution) via the drain three times per day. Once therapy was completed, the drains were removed. The first patient also remains on daily oral doxycycline for suppression for his MRSA. Both patients have remained free of clinical signs of infection at 12 and 16 months, respectively, following the completion of therapy.
Percutaneous drainage followed by antibiotic irrigation is a potential alternative to prosthetic removal when treating infected mesh in carefully selected patients.
腹疝修补术后挽救感染的假体材料很少成功。大多数病例需要切除补片并进行复杂的腹壁重建，成功率各不相同。我们报告两例采用经皮引流和抗生素冲洗的新方法挽救补片的病例。
两名患者在腹腔镜腹疝修补术后出现感染性血清肿。一名有耐甲氧西林金黄色葡萄球菌（MRSA）补片感染病史的患者接受了腹腔镜腹疝修补术，使用了一块20×23厘米的Parietex复合补片。术后两周，他出现发热，从血清肿中抽出了MRSA。另一名患者放置了一块32×33厘米的ePTFE进行修补。随后他出现了巨大的血清肿，需要反复抽吸。修补术后四个月，他出现了感染性血清肿，病原体为肺炎克雷伯菌。每名患者在超声引导下通过一根6法国猪尾导管对脓肿进行经皮引流。在静脉注射抗生素两周且临床症状缓解后，患者通过引流管接受为期4周的庆大霉素冲洗（80毫克溶于30毫升溶液中），每天三次。治疗完成后，拔除引流管。第一名患者还继续每日口服强力霉素以抑制MRSA。在治疗完成后，两名患者分别在12个月和16个月时均未出现感染的临床症状。
对于精心挑选的感染补片患者，经皮引流后抗生素冲洗是一种替代假体移除的潜在方法。
