Evaluation and management of mesh infection after inguinal hernia repair: A Delphi consensus guided by systematic review

Abstract

Background: There is limited evidence to guide the optimal evaluation and management of mesh infection after inguinal hernia repair, and real-world practices remain heterogeneous. The aim of this study is to establish expert consensus on best practices for evaluating and managing mesh infection after inguinal hernia repair. Methods: This study established expert consensus using the Delphi process, which involved 5 phases: questionnaire development, expert panel selection, questionnaire distribution, data acquisition and analysis, and iteration. This was guided by a systematic review, performed by searching the PubMed, Embase, and Cochrane databases from inception to August 22, 2024, for relevant evidence evaluated according to Oxford Centre for Evidence-Based Medicine. Results: A total of 45 experts from 22 countries participated in the Delphi process consisting of 2 rounds, and 71 articles were included in the systematic review. Computer tomography was identified as the preferred imaging modality for mesh infection (grade D). Bacteriological culture should be taken (grade D) and tested for aerobic bacteria (grade D). Broad-spectrum antibiotics should be initiated (grade D). New mesh should not be implanted in the same plane during the same procedure after infected mesh removal (grade D). Use of drains after mesh removal should be considered (grade D). Hernia recurrence after mesh removal should be addressed only after 3 months (grade D). Conclusion: Expert consensus was achieved on many aspects of the evaluation and management of mesh infection after inguinal hernia repair, but the recommendations were largely supported by grade D evidence. This study provided a framework for clinical practice guidelines and highlighted gaps that require further research.