Department of Surgery, Sanatorio Franchín, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina.
Hernia. 2009 Dec;13(6):631-7. doi: 10.1007/s10029-009-0541-y.
To analyse clinical and demographic factors of patients who suffered infection of the surgical site requiring mesh removal as a complication of prosthetic repairs, details of the hernioplasties in which meshes were implanted and their management and outcomes.
Factors related to infection (demographic variables and characteristics of the repairs and mesh utilised) and the management before proceeding to mesh removal were obtained from patient charts. Collected specimens (meshes and tissues) from 32 consecutive patients were cultured and observed microscopically. The outcomes after mesh removal were prospectively evaluated.
Twenty-two patients underwent incisional hernioplasties and ten inguinal hernioplasties; most of the procedures took a long time, and 28 patients presented early wound complications (seroma or haematoma). During the “implantation–removal” interval, some conservative treatments, such as drainages or sinus resection, were attempted under local anaesthesia. Twenty-two meshes were totally removed (nine after partial extraction); in the remaining ten cases partially removal was successful. Most of the meshes (24) were made of multi-filament polypropylene; microscopic observation of neighbouring tissues showed leucocyte infiltration, giant cell reaction, disorganisation of the collagen fibres and abscedation. Treatment of 32 patients required 51 operations. Following mesh removal, there were six recurrences and two fistulas of the bowel. The average follow-up was 40 months (30–97).
Most of the infections requiring mesh removal were related to prolonged repair operations that presented untreated early postoperative wound complications. Partial extraction of meshes frequently leads to failures and complications. Surgical exploration should be performed under general anaesthesia to accomplish complete mesh extraction.
分析因感染而需移除补片作为修复假体并发症的患者的临床和人口统计学因素，以及植入补片的疝修补术的详细信息及其管理和结果。
从患者病历中获取与感染相关的因素（人口统计学变量以及修复和使用的补片的特征）以及在进行补片移除之前的管理信息。从 32 例连续患者中采集的标本（补片和组织）进行培养并进行显微镜观察。前瞻性评估补片移除后的结果。
22 例患者行切口疝修补术，10 例患者行腹股沟疝修补术；大多数手术时间较长，28 例患者出现早期伤口并发症（血清肿或血肿）。在“植入-移除”期间，在局部麻醉下尝试了一些保守治疗，如引流或窦道切除。22 个补片被完全移除（9 个为部分取出）；在其余 10 例中，部分取出成功。大多数补片（24 个）由多股聚丙烯制成；对邻近组织的显微镜观察显示白细胞浸润、巨细胞反应、胶原纤维紊乱和脓肿形成。32 例患者的治疗共需 51 次手术。补片移除后，有 6 例复发和 2 例肠瘘。平均随访时间为 40 个月（30-97）。
大多数需要移除补片的感染与手术时间延长有关，这些手术出现未经治疗的早期术后伤口并发症。补片的部分取出常导致失败和并发症。应在全身麻醉下进行手术探查，以完成补片的完全取出。
