Textbook of Hernia by William W. Hope William S. Cobb & Gina L. Adrales

Author:William W. Hope, William S. Cobb & Gina L. Adrales
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

27.3 Peri- and Postoperative Optimization

27.3.1 Surgical Site Infection

Surgical site infections (SSIs) following incisional hernia repair has been reported to be higher than that noted with other cases designated as clean cases. It has also been shown that if the index case from which the hernia developed had a wound infection then subsequent incisional hernia repair will have a higher level of infection than would be expected from a clean case [52]. Virtually all incisional hernias greater than 4–6 cm will require mesh for optimal durable repair. In general, if a permanent synthetic mesh is used and becomes infected, the ability to sterilize the mesh and completely eradicate the infection without removing the mesh is rare. Synthetic mesh clearance rates following mesh-related wound infections are reported between 10 and 70 % and will depend on the type of mesh involved. PTFE-based meshes remain the most difficult and virtually impossible to clear, followed by multi-filament polyester, while macroporous polypropylene yields the best chance of clearance [53, 54]. The clearance rates are dependent on the type of mesh used, location of mesh placement and the extent of contamination, as well as the viability of the tissue and host defenses [1, 53]. In addition, infected mesh is associated with costly morbidities such as prolonged wound management, enterocutaneous fistulae, as well as recurrent hernia. These complications can be quite severe and expose the patient to significant morbidity and even mortality. Treating the complications of infected mesh is also quite expensive [54]; therefore, all reasonable measures should be taken to prevent wound or mesh infection.

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