SURGICAL APPROACH OF INFECTED MESH WITH ENTERO-ATMOSPHERIC FISTULA – A CASE PRESENTATION

• Main Authors: Daniel I. MIHALACHE, Bogdan SOCEA, Alexandru C. SMARANDA, Anca A. NICA, Alexandru C. CARAP, Ovidiu G. BRATU, Ana Maria A. STANESCU, Florin GROSEANU, Mihai C.T. DIMITRIU, Vlad D. CONSTANTIN
• Format: Article
• Language: English
• Published: Balkan Medical Union 2019-09-01
• Series: Archives of the Balkan Medical Union
• Subjects: mesh; infection; abdominal; hernia; repair
• Online Access: https://umbalk.org/wp-content/uploads/2019/09/29.SURGICAL-APPROACH-OF-INFECTED-MESH.pdf

Introduction. Mesh reinforcement is generally considered the standard of care in hernia repair. Infection is a common complication following hernia repair. Infection of the mesh is a complex problem. Knowledge of new treatment strategies is necessary for surgeons performing abdominal wall reconstruction. Case presentation. We present the case of a 68-year-old woman, who presented with a non-traumatic entero-atmospheric fistula at the site of the hernia repair, which had been done 2 years previously through the implantation of a dual mesh. The fistula has appeared one year previously. The treatment consisted in a complete removal of the infected mesh and segmentary enterectomy. The abdominal wall was repaired through a tissular procedure and the skin was left to close per secundam. The postoperative outcome was favorable. Conclusions. Following excision of infected mesh, multi-staged abdominal wall reconstruction can be considered. Biologic or biosynthetic mesh is recommended when repairing incisional hernias following excision of infected mesh and likely represent the patient’s best chance for a definitive hernia repair. Negative pressure wound therapy closure should be considered in higher-risk patients. Mesh infection is a complex complication that is commonly encountered by surgeons performing hernia repair. Prevention through patient optimization should be performed whenever appropriate. However, when patients develop a mesh infection, most of them will require a complete mesh excision and recurrent hernia repair.