Minimally invasive mesh salvaging technique on treatment of hernia mesh infection: A case series.

introductionThe aim of the presentation is to demonstrate a new conservative approach for the salvage treatment of the infected hernia mesh.

methodsThree patients with polypropylene mesh infection following an open umbilical and incisional hernia repair performed by placing the mesh in the onlay position are presented. The infection manifested itself with a systemic inflammatory response and an infected fluid collection surrounding the mesh. All patients were treated conservatively by a minimally invasive technique according to the stepwise protocol.

resultsAn effective, rapid response to the conservative treatment was observed. A total of five to six procedures were necessary in a period of up to twenty days. Mesh salvage was achieved, and the long-term outcome demonstrates neither the recurrence of infection nor hernia. An enclosed space at the infection site is the main precondition for providing a sufficient concentration of the antiseptic for a long enough time to act effectively at the infection site. The fast killing effect on the mesh infection and a good long-term outcome in all presented patients prove that this technique is superior to the the current techniques in appropriately selected patients from the point of treatment duration.

conclusionAn effective mesh salvaging conservative treatment is possible when the infection manifests itself as an infected fluid collection surrounding the monofilament, large-pore polypropylene mesh and should be the first-line option. Open surgical approach should be reserved as a second-line option if the first fails.