Unit of Abdominal Wall Surgery, Department of Digestive Surgery, Hospital Universitari I Politecnic "La Fe", University of Valencia, Calle Gabriel Miró 28, puerta 12, 46008, Valencia, Spain.
Klinikum Mittelbaden, Balger Strasse 50, 76530, Baden-Baden, Germany.
World J Surg. 2021 Feb;45(2):443-450. doi: 10.1007/s00268-020-05808-4. Epub 2020 Oct 6.
The goal of this article was to report the results about the efficacy of treatment of chronic mesh infection (CMI) after abdominal wall hernia repair (AWHR) in one-stage management, with complete mesh explantation of infected prosthesis and simultaneous reinforcement with a biosynthetic poly-4-hydroxybutyrate absorbable (P4HB) mesh.
This is a retrospective analysis of all patients that needed mesh removal for CMI between September 2016 and January 2019 at a tertiary center. Epidemiological data, hernia characteristics, surgical, and postoperative variables (Clavien-Dindo classification) of these patients were analyzed.
Of the 32 patients who required mesh explantation, 30 received one-stage management of CMI. In 60% of the patients, abdominal wall reconstruction was necessary after the infected mesh removal: 8 cases (26.6%) were treated with Rives-Stoppa repair, 4 (13.3%) with a fascial plication, 1 (3.3%) with anterior component separation, and 1 (3.3%) with transversus abdominis release to repair hernia defects. Three Lichtenstein (10%) and 1 Nyhus repairs (3.3%) were performed in patients with groin hernias. The most frequent postoperative complications were surgical site occurrences: seroma in 5 (20%) patients, hematoma in 2 (6.6%) patients, and wound infection in 1 (3.3%) patient. During the mean follow-up of 34.5 months (range 23-46 months), the overall recurrence rate was 3.3%. Persistent, recurrent, or new CMIs were not observed.
In our experience, single-stage management of CMI with complete removal of infected prosthesis and replacement with a P4HB mesh is feasible with acceptable results in terms of mesh reinfection and hernia recurrence.
本文旨在报告在一期手术中，对腹部疝修补术后慢性补片感染（CMI）进行治疗的疗效结果，即完全取出感染的补片假体，并同时使用生物可吸收聚 4-羟基丁酸酯（P4HB）补片进行加固。
这是对 2016 年 9 月至 2019 年 1 月在一家三级中心因 CMI 需要移除补片的所有患者进行的回顾性分析。分析这些患者的流行病学数据、疝特征、手术和术后变量（Clavien-Dindo 分类）。
在 32 名需要移除补片的患者中，有 30 名接受了 CMI 的一期治疗。在 60%的患者中，在移除感染的补片后需要进行腹壁重建：8 例（26.6%）采用 Rives-Stoppa 修复，4 例（13.3%）采用筋膜折叠术，1 例（3.3%）采用前组件分离术，1 例（3.3%）采用腹横肌释放术修复疝缺损。3 例（10%）Lichtenstein 和 1 例（3.3%）Nyhus 修复术用于治疗腹股沟疝患者。最常见的术后并发症是手术部位并发症：5 例（20%）患者出现血清肿，2 例（6.6%）患者出现血肿，1 例（3.3%）患者出现伤口感染。在平均 34.5 个月（23-46 个月）的随访期间，总复发率为 3.3%。未观察到持续性、复发性或新的 CMI。
根据我们的经验，在一期手术中，完全取出感染的假体并用 P4HB 补片替换，对于补片再感染和疝复发，是一种可行且可接受的方法。
