Tertiary Care Centre, Pune, 411040, Maharashtra, India.
Professor Surgery & GI Surgery, Vishakhapatnam, Andhra Pradesh, India.
Hernia. 2020 Aug;24(4):849-856. doi: 10.1007/s10029-020-02142-5. Epub 2020 Feb 24.
Mesh hernioplasty is the most common surgery for hernia repair with Polypropylene mesh as the preferred one. But the use of synthetic prosthesis is associated with the inherited risk of developing a prosthetic infection that may manifest even after a very long time as subtle symptoms in the form of fever, myalgia, erythema of overlying skin and in some cases as chronic discharging sinus. With this in view a systematic prospective observational study has been carried out to estimate the incidence of mesh infections, to identify the type of associated organism and to study the outcome of the cases with hernioplasty using Propylene mesh.
Mesh hernioplasty performed in all adult patients using propylene mesh exclusively on 161 males and 20 females were considered in this prospective observational study carried out for 3 years (2016-2019) at tertiary care centre and teaching hospital in India. A standard size of the propylene mesh and well laid procedures were used for surgery as well as post operative care, identification and culture of microorganism. The patients were followed up to identify any symptoms of SSI or mesh infection. The entire data was statistically analyzed using Statistical Package for Social Sciences (SPSS ver 21.0, IBM Corporation, USA) for MS Windows.
Out of 181 cases, the mesh contamination was observed in 59 cases while total cases of mesh infection were nine (09), which include 07 males and 02 females. The cases that developed infection were of mostly groin hernias. The cases commonly presenting with erythema, seroma and surgical wound dehiscence with identification of methicillin sensitive Staphylococcus aureus (MSSA) in the few samples of the wound discharge were managed conservatively and none of the cases had to undergo mesh explantation. Of the numerous factors viz. age, sex, associated co-morbidities, educational status, socio-economic status, duration of surgery and expertise of the operating surgeon, the two factors viz. duration of surgery and the mesh contamination were found to be associated with mesh infection in a statistically significant way.
The incidence of mesh infection was observed in 4.97% of total 181 cases. To the best of knowledge, this seems to be the first prospective observational carried out in this country. Of the numerous factors studied, the duration of surgery and mesh contamination were the factors found to have statistical significance on the incidence of mesh infection. Although a clear picture to differentiate surgical site infection from acute mesh infection is yet to be obtained, the study provided better understanding of the management as no mesh explantation was required in either of the cases.
网片修补术是疝修补术最常用的方法，其中以聚丙烯网片为首选。但是，使用合成假体与发生假体感染的固有风险相关，即使在很长时间后，这种感染也可能以发热、肌痛、覆盖皮肤的红斑以及在某些情况下慢性排脓窦等微妙症状表现出来。有鉴于此，进行了一项系统的前瞻性观察研究，以估计网片感染的发生率，确定相关病原体的类型，并研究使用聚丙烯网片进行疝修补术的病例结果。
本前瞻性观察研究纳入了 2016 年至 2019 年在印度一家三级护理中心和教学医院接受单纯聚丙烯网片修补术的 161 例男性和 20 例女性成年患者。该研究使用标准尺寸的聚丙烯网片，并严格遵循手术和术后护理程序，对微生物进行鉴定和培养。通过随访来识别任何 SSI 或网片感染的症状。使用社会科学统计软件包（SPSS ver 21.0，IBM 公司，美国）对所有数据进行统计学分析。
在 181 例患者中，有 59 例发生网片污染，9 例（09 例）发生网片感染，其中 7 例为男性，2 例为女性。发生感染的病例主要为腹股沟疝。最常见的表现为红斑、血清肿和手术切口裂开，少数伤口分泌物中检出对甲氧西林敏感的金黄色葡萄球菌（MSSA），这些病例经保守治疗后，均无需进行网片取出术。在对年龄、性别、合并症、教育程度、社会经济状况、手术时间和手术医生经验等诸多因素进行分析后，发现手术时间和网片污染这两个因素与网片感染显著相关。
在 181 例患者中，网片感染的发生率为 4.97%。据我们所知，这似乎是在该国进行的第一项前瞻性观察研究。在所研究的诸多因素中，手术时间和网片污染是与网片感染相关的两个具有统计学意义的因素。虽然还需要进一步研究以明确区分手术部位感染和急性网片感染，但本研究为治疗提供了更好的理解，因为在任何情况下均无需进行网片取出术。
