Treatment of infected wounds of the abdominal wall after mesh hernia repair
Keywords:wound infection of abdominal wall, mesh heria repair, abdominal hernia alloplasty, ultrasound cavitation, VAC therapy, decamethoxine solution, chlorhexidine digluconate solution
Background. An infected wound of the abdominal wall after mesh hernia repair is related to mesh infection, because mesh is situated at the bottom of the wound and granulation tissue doesn’t cover it. Infected mesh wounds have traditionally been treated by surgically removing the mesh which causes prolonged hospitalizations and hernia recurrence. Objective of the study is to increase the efficiency of treatment of wounds infection after mesh heria repair.
Маterials and methods. We analyzed the results of wound infection treatment in 72 patients. 37 patients (group I) were treated according to the developed algorithm (ultrasound cavitation, VAC-therapy and decamethoxine solution), 35 (group II) were treated according to the traditional one (ultrasound cavitation, VAC-therapy and chlorhexidine digluconate solution).
Results. The number of microbial colonies (CFU) in the wound decreased to lg (2.33 ± 0.51) CFU/ml and lg (1.35 ± 0.49) CFU/ml in group I against lg (4.01 ± 0) CFU/ml and lg (2.93 ± 0.56) CFU/ml in group II. (p < 0.01) The results of morphological examination of the wound edges confirmed more efficient growth of connective tissue in patients of group I (mesh was completely covered with granulation tissue) which improved wound healing. While in group II, mesh explantation was performed in 5 (14.3 %) patients (granulation tissue hasn’t covered mesh completely). The duration of wound healing in patients of group I was 16 ± 1.05 days, compared with 21 ± 1.2 days in group II (p < 0.01). We achieved better results through the use of the developed algorithm in group I, in particular the combination of ultrasound cavitation, VAC therapy and decametoxine solution, which has not only antimicrobial action, but also promotes connective tissue repair in the wound.
Conclusion. Developed algorithm for wounds infection treatment after alloplasty, which includes ultrasound cavitation, VAC-therapy and decamethoxine solution, improves treatment outcomes, reduced wound healing time to 16 ± 1.05 days in patients of the main group against 21 ± 1.2 in comparison group, and excludes the possibility of mesh explantation in the main group against 14.3 % in the comparison group.
Ramos RD, O’Brien WJ, Gupta K, Itani KM. Incidence and risk factors for long-term mesh explantation due to infection in more than 100,000 hernia operation patients. Journal of the American College of Surgeons. 2021 Jun 1;232(6):872-80. Available from: https://doi.org/10.1016/j.amjsurg.2016.03.007
Aiolfi A, Cavalli M, Micheletto G, Bruni PG, Lombardo F, Morlacchi A, Bonitta G, Campanelli G, Bona D. Open mesh vs. suture umbilical hernia repair: systematic review and updated trial sequential meta-analysis of randomized controlled trials. Hernia. 2020 Aug;24(4):707-15. Available from: https://doi.org/10.1007/s10029-020-02146-1
Feleschtinskij JP. Postoperative abdominal hernias [Pisliaoperatsiini hryzhi zhyvota]. Kyiv: TOV “Bisnes-Lohika”. 2012; 9:137-53. [In Ukrainian]
Madion M, Goldblatt MI, Gould JC, Higgins RM. Ten-year trends in minimally invasive hernia repair: a NSQIP database review. Surgical Endoscopy. 2021 Dec;35(12):7200-8. Available from: https://doi.org/10.1007/s00464-020-08217-9
Maurel A, Karadimos D, Wysocki AP. Management of Infected Mesh After Lichtenstein Hernia Repair: a Systematic Review. SN Comprehensive Clinical Medicine. 2019 Sep;1(9):730-6. Available from: https://doi.org/10.1007/s42399-019-00114-0
Perez AJ, Strassle PD, Sadava EE, Gaber C, Schlottmann F.J of Laparoendoscopic & Advanced Surg Techniques. [Internet] 2020 Mar;30(3):292-8. Available from: http://doi.org/10.1089/lap.2019.0656
Alkhatib H, Tastaldi L, Krpata DM, Petro CC, Huang LC, Phillips S, et al. Impact of modifiable comorbidities on 30-day wound morbidity after open incisional hernia repair. Surgery. [Internet] 2019 July;166(1):94–101. Available from: https://doi.org/10.1016/j.surg.2019.03.011
Bueno-Lledo J, Torregrosa-Gallud A, Sala-Hernandez A, Carbonell-Tatay F, Pastor PG, Diana SB, et al. Predictors of mesh infection and explantation after abdominal wall hernia repair. Am J Surg. [Internet]. 2017 Jan [cited 2016 Jun];213(1):50-7. Available from: https://doi.org/10.1016/j.amjsurg.2016.03.007
Plymale MA, Davenport DL, Walsh-Blackmore S, Hess J, Griffiths WS, Plymale MC, et al. Costs and Complications Associated with Infected Mesh for Ventral Hernia Repair. Surgical Infections [Internet]. 2020 May 30 [cited 2020 Arp 30];21(4):344–9. Available from: https://doi.org/10.1089/sur.2019.183
Sharma R, Fadaee N, Zarrinkhoo E, Towfigh S. Why we remove mesh. Hernia. [Internet]. 2018 Oct [cited 2018 Dec];22(6):953-9 Available from: https://doi.org/10.1007/s10029-018-1839–4
Tubre AD, Schroeder DJ, Estes J, Eisenga J, Fitzgibbons RJ. Surgical site infection: the “Achilles Heel” of all types of abdominal wall hernia reconstruction. Hernia. [Internet]. 2018 Oct;22:1003–13. Available from: https://doi.org/10.1007/s10029-018-1826-9
Feleshtynsky JP, Derkach KD, Smishchuk VV, Sposib likuvannia infikovanoii rany cherevnoii stinky pislia aloplastyky hryzhi zhyvota. Avtorske parvo na tvir Ukrainy №106035 2021 Jul 8 [In Ukrainian] Available from: https://sis.ukrpatent.org/uk/search/detail/1618383/
Rosai J. Rosai and Ackerman's surgical pathology e-book. Elsevier Health Sciences; 2011 Jun 20;Chapter 2-3:25-95
How to Cite
This work is licensed under a Creative Commons Attribution 4.0 International License.
This work is licensed under a Creative Commons Attribution 4.0 International License