Chronic Mesh Infection after Incisional Hernia Repair. Factors Influencing Negative Outcomes of Complete Mesh Removal.

Background: The treatment of incisional hernias has radically changed over the last 50 years due to the introduction of mesh repair, which has been proven to be superior to tissue repairs in terms of recurrence. Severe complications such as bacterial contamination, enteral fistulas and severe visceral adhesions are the bane of mesh repair and lead to great challenges as far as treatment is concerned. Methods: From January 2009 to December 2018, we retrospectively collected operative and outcome data on reoperation following septic complications of incisional hernias (IH) mesh repair in 89 patients. For adjustment, comorbidities, mesh location, prognostic nutritional index (PNI) and operative time were included in an SPSS data analyzer. Results: in the referred interval 89 patients (29 males) met the inclusion criteria. The mean time for the onset of infections 15.04+-0.95 months and the number of previous abdominal interventions varied from 1 to 5. Wound infections were reported to be the primary factor for mesh infection. Following removal only 43% of meshes were found to be positive for bacterial infections; the most common species detected being , MRSA and, . Different techniques of mesh removal and abdominal wall closure were used. After abdominal wall closure, 54% of patients developed post-operative complications with a mortality of 12%. Conclusion: The risk of infection after abdominal wall reconstruction (AWR) appears to be higher than other clean abdominal procedures. Mesh removal is mandatory when the infection prolonged over 3 months. The procedure is associated with a high rate of morbidity and mortality and with low quality of life if the abdomen can't be closed. Prevention is the best treatment option.

Transinguinal Preperitoneal Mesh Plasty - An Alternative or a Dispensable Technique? A Prospective Analyze vs Lichtenstein Repair for Complex Unilateral Groin Hernias.

Background: complex groin hernia is a well describe entity with a high risk of recurrence and postoperative complications. There is no standardized approach and no reports to confirm the efficcacy of a surgical procedure. Our goal was to compare Lichtenstein repair (LR) as "golden standard" for open anterior approach with the transinguinal preperitoneal plasty (TIPP) in the treatment of complex groin hernia repair. Material and methods: the study was a prospective one and includes all patients with complex hernias admitted in the Department of Surgery of the Military Hospital Cluj-Napoca between January 2010 and December 2014. All the patients were randomized in two groups: LR and TIPP. Baseline characteristics, intraoperative findings, pain and complications were recorded. Follow-up was at least 1 year. The main outcome after 1 year were recurrence, chronic pain and its intensity recorded on VAS scale. Results: 205 patients (101 in LR group and 104 in TIPP) were included in the study. There were no differences in baseline characteristics and operative findings. Postoperative pain was lower for TIPP group (p 0.05). Follw-up was 98% at 1 month, 74% after 6 months and 64% after 1 year. Recurrence rate was higher for LR (p=0.027). Pain was increased in LR group. Conclusion: TIPP is equal in terms of chronic pain and recurrence for complex groin inguinal hernias.