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What is the outcome of late-onset infected mesh removal after open tension-free inguinal hernioplasty: 3-year follow-up

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Abstract

Purpose

Reports of mesh infections following open tension-free inguinal hernioplasty are gradually increasing. Recent research has focused on identifying and managing mesh infections. However, studies examining the long-term outcomes and quality of life following mesh removal for late-onset infections are few. This study aimed to analyze the short and long-term outcomes after maximal removal of the implanted mesh in patients with late-onset mesh infection after open tension-free inguinal hernioplasty.

Methods

Data of 105 patients who developed late-onset mesh infection after open tension-free inguinal hernioplasty and were admitted to our hospital from January 2014 to January 2019 were retrospectively analyzed. Patients were followed up by telephone or outpatient consultation for 3 years, focusing on hernia recurrence and mesh infection recurrence. Quality of life was assessed preoperatively and postoperatively using our developed scale; postoperative inguinal area pain was assessed using the visual analog score, and postoperative anxiety was assessed using the anxiety self-assessment scale.

Results

Of the 105 patients who experienced late-onset mesh infection following open inguinal hernioplasty, 100 underwent mesh plug repair. The mean follow-up time was 58 months, and 10.5% (95/105) of the patients were lost to follow-up. Recurrence of infection was observed in 28.6% of patients (2/7) who underwent partial mesh removal and in 3.4% of patients (3/88) who underwent complete mesh removal. One inguinal hernia recurred 12 months after mesh removal (1.0% recurrence rate). In the third year following surgery as compared to the preoperative period, there were significant improvements in quality of life.

Conclusions

Hernia plugs may not be a good choice in tension-free inguinal hernia repair in view of the risk of late infections and fistulas. Remove all mesh at the time of the first operation for mesh infection. Hernia recurrence after late-onset infected mesh removal following open inguinal tension-free hernioplasty is rare. The post-operative quality of life, pain, and anxiety are gradually steadily improving.

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References

  1. Lichtenstein IL et al (1989) The tension-free hernioplasty. Am J Surg 157(2):188–193

    Article  CAS  PubMed  Google Scholar 

  2. Delikoukos S et al (2007) Late-onset deep mesh infection after inguinal hernia repair. Hernia 11(1):15–17

    Article  CAS  PubMed  Google Scholar 

  3. Pérez-Köhler B, Bayon Y, Bellón JM (2016) Mesh infection and hernia repair: a review. Surg Infect 17(2):124–137

    Article  Google Scholar 

  4. Rehman S et al (2012) Recurrence of inguinal herniae following removal of infected prosthetic meshes: a review of the literature. Hernia 16(2):123–126

    Article  CAS  PubMed  Google Scholar 

  5. Kao AM et al (2018) Prevention and treatment strategies for mesh infection in abdominal wall reconstruction. Plast Reconstr Surg 142:149S-155S

    Article  CAS  PubMed  Google Scholar 

  6. Levy S et al (2018) Comparison of complete versus partial mesh removal for the treatment of chronic mesh infection after abdominal wall hernia repair. Hernia 22(5):773–779

    Article  CAS  PubMed  Google Scholar 

  7. Mann DV et al (1998) Late-onset deep prosthetic infection following mesh repair of inguinal hernia. Am J Surg 176(1):12–14

    Article  CAS  PubMed  Google Scholar 

  8. Kong W et al (2015) Early-versus late-onset prosthetic mesh infection: more than time alone. Indian J Surg 77(Suppl 3):1154–1158

    Article  PubMed  PubMed Central  Google Scholar 

  9. Hays RD, Sherbourne CD, Mazel RM (1993) The RAND 36-item health survey 1.0. Health Econ 2(3):217–227

    Article  CAS  PubMed  Google Scholar 

  10. Skevington SM et al (2021) Enhancing the multi-dimensional assessment of quality of life: introducing the WHOQOL-Combi. Qual Life Res 30(3):891–903

    Article  PubMed  Google Scholar 

  11. Thompson AJ, Turner AJ (2020) A comparison of the EQ-5D-3L and EQ-5D-5L. Pharmacoeconomics 38(6):575–591

    Article  PubMed  Google Scholar 

  12. HerniaSurge Group (2018) International guidelines for groin hernia management. Hernia 22(1):1–165

    Article  Google Scholar 

  13. McCarthy MJ et al (2005) Visual analog scales for assessing surgical pain. J Am Coll Surg 201(2):245–252

    Article  PubMed  Google Scholar 

  14. Zung WW (1965) A self-rating depression scale. Arch Gen Psychiatry 12:63–70

    Article  CAS  PubMed  Google Scholar 

  15. Tamura T, Ohata Y, Katsumoto F (2019) Mesh removal and reconstruction with posterior components separation technique for delayed mesh infection developed 10 years after abdominal incisional hernia repair: a rare case report. Surg Case Rep 5(1):140

    Article  PubMed  PubMed Central  Google Scholar 

  16. Fawole AS, Chaparala RP, Ambrose NS (2006) Fate of the inguinal hernia following removal of infected prosthetic mesh. Hernia 10(1):58–61

    Article  CAS  PubMed  Google Scholar 

  17. Jin C, Shen Y, Chen J (2020) Laparoscopic evaluation and management of 47 patients with late-onset mesh infection after inguinal hernioplasty. Hernia 24(2):381–385

    Article  CAS  PubMed  Google Scholar 

  18. Klinge U, Klosterhalfen B (2012) Modified classification of surgical meshes for hernia repair based on the analyses of 1,000 explanted meshes. Hernia 16(3):251–258

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Agrawal A, Avill R (2006) Mesh migration following repair of inguinal hernia: a case report and review of literature. Hernia 10(1):79–82

    Article  CAS  PubMed  Google Scholar 

  20. Amid PK (2003) The Lichtenstein repair in 2002: an overview of causes of recurrence after Lichtenstein tension-free hernioplasty. Hernia 7(1):13–16

    Article  CAS  PubMed  Google Scholar 

  21. Brown C, O’Hare R, Stephenson BM (2022) Avoiding migration at open mesh plug inguinal hernioplasty. Heliyon 8(5):e09320

    Article  PubMed  PubMed Central  Google Scholar 

  22. D’Amore L et al (2012) Mesh plug repair: can we reduce the risk of plug erosion into the sigmoid colon? Hernia 16(4):495–496

    Article  CAS  PubMed  Google Scholar 

  23. Li J, Cheng T (2019) Mesh erosion into urinary bladder, rare condition but important to know. Hernia 23(4):709–716

    Article  CAS  PubMed  Google Scholar 

  24. Trabucco EE (1993) The office hernioplasty and the Trabucco repair. Ann Ital Chir 64(2):127–149

    CAS  PubMed  Google Scholar 

  25. Robbins AW, Rutkow IM (1993) The mesh-plug hernioplasty. Surg Clin North Am 73(3):501–512

    Article  CAS  PubMed  Google Scholar 

  26. Bueno-Lledo J et al (2017) Partial versus complete removal of the infected mesh after abdominal wall hernia repair. Am J Surg 214(1):47–52

    Article  PubMed  Google Scholar 

  27. Gachabayov M et al (2020) Recurrence of infection and hernia following partial versus complete removal of infected hernia mesh: a systematic review and cohort meta-analysis. Hernia 24(3):433–439

    Article  CAS  PubMed  Google Scholar 

  28. Sabbagh C et al (2012) Partial removal of infected parietal meshes is a safe procedure. Hernia 16(4):445–449

    Article  CAS  PubMed  Google Scholar 

  29. Chung L, Tse GH, O’Dwyer PJ (2014) Outcome of patients with chronic mesh infection following abdominal wall hernia repair. Hernia 18(5):701–704

    Article  CAS  PubMed  Google Scholar 

  30. Yang H et al (2020) Study of mesh infection management following inguinal hernioplasty with an analysis of risk factors: a 10-year experience. Hernia 24(2):301–305

    Article  CAS  PubMed  Google Scholar 

  31. Arnaud JP et al (1977) Critical evaluation of prosthetic materials in repair of abdominal wall hernias: new criteria of tolerance and resistance. Am J Surg 133(3):338–345

    Article  CAS  PubMed  Google Scholar 

  32. Akyol C et al (2013) Outcome of the patients with chronic mesh infection following open inguinal hernia repair. J Korean Surg Soc 84(5):287

    Article  PubMed  PubMed Central  Google Scholar 

  33. Sanders DL et al (2014) Randomized clinical trial comparing self-gripping mesh with suture fixation of lightweight polypropylene mesh in open inguinal hernia repair. Br J Surg 101(11):1373–1382

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of General Surgery, Shaanxi Provincial People’s Hospital, Xi’an, 710068, China

    Zhouhang Zhi, Hang Cui, Wanlin Han, Chun Deng & Xiaojun Li

  2. Yan’an University, Yan’an, China

    Zhouhang Zhi

Authors
  1. Zhouhang Zhi
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  2. Hang Cui
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  3. Wanlin Han
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  4. Chun Deng
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  5. Xiaojun Li
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Contributions

ZZ and HC: conceived the study and drafted the manuscript. WH and CD: identified and screened clinical data of patients eligible for late-onset mesh infection. ZZ and HC: extracted data independently and consulted with WH when controversial issues were raised. XL: revised and directed the study. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Xiaojun Li.

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The authors declare that they have no conflict of interest.

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Ethical approval was agreed by the ethical committee of the institution.

Human and animal rights

The study including human participants has been performed in accordance with the ethical standards of the Declaration of Helsinki and its later amendments.

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Informed consent was obtained from all individual participants included in the study.

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Zhi, Z., Cui, H., Han, W. et al. What is the outcome of late-onset infected mesh removal after open tension-free inguinal hernioplasty: 3-year follow-up. Hernia 27, 935–942 (2023). https://doi.org/10.1007/s10029-022-02684-w

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  • DOI: https://doi.org/10.1007/s10029-022-02684-w

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