ArticleHernia : the journal of hernias and abdominal wall surgery2026
A practical algorithm for the management of mesh infection in abdominal wall surgery: learnings after 20 years of experience.
Article in Hernia : the journal of hernias and abdominal wall surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionMesh-related complications, particularly mesh infections (CMIs), remain a serious clinical challenge with significant morbidity, increased healthcare costs, and negative impacts on patient quality of life. This article proposes a comprehensive protocol for managing CMIs in abdominal wall hernia repair (AWHR), synthesising our experience about this treatment after 20 years and evidence from recent clinical studies and addressing key management controversies.
methodsA retrospective analysis was conducted using a prospectively maintained database of patients diagnosed with CMI who underwent elective open AWHR between January 2004 and May 2024 at a tertiary referral centre. CMI was diagnosed by detecting pathogenic microorganisms in periprosthetic fluid collected via surgical drainage or ultrasound-guided percutaneous aspiration after AWHR. Mesh explantation was defined as any subsequent procedure in which the prosthesis was partially or completely removed.
resultsOver the 20-year study period (January 2004 to May 2024), 3,892 AWHRs were performed at our hospital. At a median of 31.6 months (range: 15–55 months) of postoperative follow-up, 128 cases of CMI were reported, of which 84 cases were clinically diagnosed within one year of AWHR and 44 cases after one year. The overall CMI rate after AWHR was 3.2%. Of these cases, 118 (92.1%) patients required mesh explantation as the definitive treatment. The most frequent clinical presentation of CMI was postoperative chronic sinus tract drainage (94%) and mesh extrusion through the wound (6%). We observed 32.2% postoperative surgical site occurrences in our study in both management approaches. The overall recurrence rate after prosthesis explantation was 16.1%, and reinfection of the new mesh was 5%; all patients were reported in the two-stage management approach.
conclusionsCMI following AWHR remains one of the most challenging complications in hernia surgery, despite advances in surgical techniques and materials. The establishment of an algorithm incorporating these insights is critical to improving clinical outcomes and optimising mesh infection management.
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