Mesh removal and ventral hernia repair with long-term absorbable mesh in case of mesh infection

Abstract

Purpose: Mesh infection after ventral hernia repair remains rare, but often necessitates mesh removal. This study evaluated the short- and long-term outcomes of a strategy involving explantation of the infected mesh and insertion of a long-term absorbable mesh in acute (AMI) and chronic mesh infections (CMI). Methods: A retrospective study was performed in two tertiary centers (01.01.2017–31.12.2024). All consecutive patients with ventral mesh infection who underwent mesh explantation followed by placement of a long-term absorbable poly-4-hydroxybutyrate mesh were included. Primary endpoint was hernia recurrence rate. AMI was defined as mesh infection within 90 postoperative days. Results: Twenty-nine patients were included: 14 AMI/15 CMI. Meshes were intraperitoneal in 9/14 (64%) AMI and in 13/15 (87%) CMI patients. Twelve (86%) and 13 patients (87%) had a new mesh implanted in the retromuscular space in the AMI and CMI groups, respectively. Four (28%) and 3 patients (21%) needed posterior component separations in the AMI and CMI groups. Median hospital stays were 10 (5–15) and 7 days (5–13) in both groups. Nine patients in each group (64%/60%) developed postoperative complications. Hernia recurrence rates were 3/14 (21%) and 0 in the AMI and CMI groups (mean follow-up 17 months). One mesh had to be explanted in the AMI group (0 in the CMI group). Conclusions: The presented strategy was associated with high short-term morbidity, but good long-term results, with low mesh explantation and hernia recurrence rates. A longer follow-up and inclusion of more patients is required to assess the risk of hernia recurrence and reinfection with greater hindsight.