Alfa Institute of Biomedical Sciences (AIBS), 9 Neapoleos Street, 151 23, Marousi, Athens, Greece.
World J Surg. 2011 Nov;35(11):2389-98. doi: 10.1007/s00268-011-1266-5.
Mesh infection, although infrequent, is a devastating complication of mesh hernioplasties. The aim of this study was to systematically review and synthesize the available evidence on risk factors for synthetic mesh infection after hernioplasty. A systematic search was performed in PubMed and Scopus databases. The extracted data were synthesized with the methodology of meta-analysis. We identified six eligible studies that reported on 2,418 mesh hernioplasties. The crude mesh infection rate was 5%. Statistically significant risk factors were smoking (risk ratio [RR] = 1.36 [95% confidence interval (CI): 1.07, 1.73]; 1,171 hernioplasties), American Society of Anesthesiologists (ASA) score ≥3 (RR = 1.40 [1.15, 1.70]; 1,682 hernioplasties), and emergency operation (RR = 2.46 [1.56, 3.91]; 1,561 hernioplasties). Also, mesh infections were significantly correlated with patient age (weighted mean difference [WMD] = 2.63 [0.22, 5.04]; 2,364 hernioplasties), ASA score (WMD = 0.23 [0.08, 0.38]; 1,682 hernioplasties), and the duration of the hernioplasty (WMD = 44.92 [25.66, 64.18]; 833 hernioplasties). A trend toward higher mesh infection rates was observed in obese patients (RR = 1.41 [0.94, 2.11]; 2,243 hernioplasties) and in patients operated on by a resident (in contrast to a consultant; RR = 1.18 [0.99, 1.40]; 982 hernioplasties). Mesh infections usually resulted in mesh removal, and common pathogens included Staphylococcus spp., Enterococcus spp., and gram-negative bacteria. Patient age, ASA score, smoking, and the duration and emergency setting of the operation were found to be associated with the development of synthetic mesh infection. The heterogeneity of the available evidence should be taken under consideration. Prospective studies with a meticulous follow-up are warranted to further investigate mesh-related infections.
网片感染虽然不常见，但却是网片修补术后一种毁灭性的并发症。本研究旨在系统回顾和综合现有关于疝修补术后合成网片感染危险因素的证据。在 PubMed 和 Scopus 数据库中进行了系统检索。提取的数据采用荟萃分析方法进行综合。我们确定了 6 项符合条件的研究，这些研究报告了 2418 例网片修补术。总的网片感染率为 5%。有统计学意义的危险因素包括吸烟（风险比 [RR] = 1.36 [95%置信区间 (CI): 1.07, 1.73]；1171 例修补术）、美国麻醉师协会 (ASA) 评分≥3（RR = 1.40 [1.15, 1.70]；1682 例修补术）和急诊手术（RR = 2.46 [1.56, 3.91]；1561 例修补术）。此外，网片感染与患者年龄（加权均数差 [WMD] = 2.63 [0.22, 5.04]；2364 例修补术）、ASA 评分（WMD = 0.23 [0.08, 0.38]；1682 例修补术）和疝修补术持续时间（WMD = 44.92 [25.66, 64.18]；833 例修补术）显著相关。在肥胖患者（RR = 1.41 [0.94, 2.11]；2243 例修补术）和由住院医师（与顾问相比；RR = 1.18 [0.99, 1.40]；982 例修补术）实施手术的患者中，网片感染率呈上升趋势。网片感染通常导致网片移除，常见病原体包括金黄色葡萄球菌、肠球菌和革兰氏阴性菌。患者年龄、ASA 评分、吸烟以及手术持续时间和紧急情况与合成网片感染的发生有关。应考虑到现有证据的异质性。需要前瞻性研究进行细致的随访，以进一步调查与网片相关的感染。
