Case Report: A case of severe chronic infection of an intraperitoneally placed composite mesh treated with complete mesh explantation and primary tissue repair using the anterior component separation technique.

Introduction: The introduction of synthetic mesh has fundamentally changed the management of ventral hernias by substantially reducing recurrence rates compared with primary suture repair. However, mesh implantation carries an inherent risk of foreign body-related complications, most notably mesh infection. Although uncommon, mesh infection following ventral hernia repair is a potentially devastating complication that often requires complex surgical management. Treatment strategies range from attempts at mesh preservation to complete mesh explantation followed by abdominal wall reconstruction with or without the use of a biologic mesh. The leading risk factors for mesh infection include postoperative wound complications and inappropriate mesh selection or placement. Case presentation: We present the case of a 29-year-old man who sustained a splenic rupture in a traffic accident. At another institution, he underwent emergency splenectomy, during which a large composite mesh was implanted in the intraperitoneal position. Approximately three months later, purulent discharge developed from the laparotomy wound, followed shortly thereafter by exposure of part of the mesh. He presented to our institution with a large ventral hernia, extensive exposure of an infected mesh, and persistent purulent drainage. Abdominal MSCT excluded an enteric fistula and demonstrated a ventral hernia with a transverse defect measuring 14 cm, together with conglomerates of contracted mesh located beneath the skin. Complete mesh explantation was performed, followed by definitive abdominal wall reconstruction without implantation of a new mesh. Primary tissue repair was achieved using anterior component separation to facilitate tension-free midline fascial closure. The operation and postoperative recovery were uneventful. Discussion: Mesh infection remains an important complication of ventral hernia repair and is likely to continue to be encountered in clinical practice. Nevertheless, the clinical benefits of mesh-based repair generally outweigh the associated risks, and mesh implantation remains the standard of care for most ventral hernias. Future efforts should therefore focus on preventing mesh infection, particularly through structured surgeon education on appropriate mesh selection, optimal mesh placement, and adherence to sound surgical principles in ventral hernia repair.