Bueno-Lledó José, Carreño-Sáenz Omar, Perez-Alonso Carla, Martinez-Hoed Jesus, Pous-Serrano Salvador
Unit of Abdominal Wall Surgery, Department of Digestive Surgery, Hospital Universitari i Politecnic "La Fe". University of Valencia, Calle Gabriel Miró 28, puerta 12, Valencia, 46008, Spain.
Unit of Abdominal Wall Surgery. R. A. Calderón Guardia Hospital, San José, Costa Rica.
Hernia. 2025 Jun 5;29(1):199. doi: 10.1007/s10029-025-03395-8.
Mesh infection (CMI) after ventral hernia repair (VHR) is uncommon, with an incidence of 1-7%. The aim of this observational retrospective study was (1) to analyse the incidence and aetiologies of late CMI (one or more years after prosthetic repair) in a series of VHR patients, (2) to identify pre-operative and perioperative variables related to late CMI and (3) to consider possible prevention measures to reduce its occurrence.
A multivariate analysis of a prospective database of patients with a diagnosis of CMI who underwent open VHR between January 2014 and December 2023 at a tertiary centre was conducted. Institutional review board approval was obtained. Two groups of patients were compared: patients with onset of CMI less than one year after VHR (early CMI [ECMI] group) and patients with onset of CMI (sinus or suspected infection) one or more years after VHR (late CMI [LCMI] group).
At a median of 31.6 months (range: 19-55 months) of post-operative followup, 108 cases of CMI were reported, of which 64 cases were clinically diagnosed within one year of VHR (ECMI group) and 44 cases after one year (LCMI group). The most frequent clinical presentation of CMI was post-operative chronic sinus (94%) and mesh extrusion through the wound (6%). In multivariate analysis, pre-operative predictors associated with LCMI were BMI > 30 (p < 0.001; OR 1.980, p=0.002) and steroid or immunosuppressive drug use (p < 0.001; OR 1.06, p=0.004). Previous hernia repair using PTFE mesh was also a predictor of LCMI (p < 0.002; OR 2.11, p=0.000). Various factors, such as smoking, diabetes, previous hernia repair, presence of a stoma, operative time, concomitant enterotomy or post-operative SSI, were not significant indicators of LCMI.
CMI is one of the most prevalent and challenging complications of VHR. Obesity (BMI > 30) and immunosuppression, as well as the use of ePTFE mesh in the previous hernia repair, are predictors of LCMI after VHR; studies of these factors may reduce and prevent the occurrence of LCMI.
腹侧疝修补术（VHR）后发生补片感染（CMI）并不常见，发生率为1%-7%。这项观察性回顾性研究的目的是：（1）分析一系列VHR患者中迟发性CMI（假体修补术后一年或更长时间）的发生率和病因；（2）确定与迟发性CMI相关的术前和围手术期变量；（3）考虑可能的预防措施以减少其发生。
对2014年1月至2023年12月在一家三级中心接受开放性VHR且诊断为CMI的患者的前瞻性数据库进行多变量分析。获得了机构审查委员会的批准。比较两组患者：VHR术后不到一年发生CMI的患者（早期CMI[ECMI]组）和VHR术后一年或更长时间发生CMI（窦道或疑似感染）的患者（迟发性CMI[LCMI]组）。
术后中位随访31.6个月（范围：19-55个月），报告了108例CMI病例，其中64例在VHR术后一年内临床诊断（ECMI组），44例在一年后诊断（LCMI组）。CMI最常见的临床表现是术后慢性窦道（94%）和补片经伤口挤出（6%）。在多变量分析中，与LCMI相关的术前预测因素为BMI>30（p<0.001；OR 1.980，p=0.002）和使用类固醇或免疫抑制药物（p<0.001；OR 1.06，p=0.004）。既往使用聚四氟乙烯补片进行疝修补术也是LCMI的一个预测因素（p<0.002；OR 2.11，p=0.000）。吸烟、糖尿病、既往疝修补术、造口的存在、手术时间、同期肠切开术或术后手术部位感染等各种因素不是LCMI的显著指标。
CMI是VHR最常见且具有挑战性的并发症之一。肥胖（BMI>30）和免疫抑制，以及既往疝修补术中使用ePTFE补片，是VHR术后LCMI的预测因素；对这些因素的研究可能会减少和预防LCMI的发生。
