Surgical site infection in mesh repair for ventral hernia in contaminated field: A systematic review and meta-analysis

Abstract

Background Given the risk of surgical site infection (SSI), the use of mesh in contaminated ventral hernia repair (VHR) is not standardized and still a clinical dilemma. This meta-analysis aimed to assess whether mesh use increased the risk of SSI in patients following VHR in contaminated field. Methods We performed a systematic review of published literature. Studies comparing the mesh repair and anatomic repair, the use of mesh in different Center for Disease Control and Prevention (CDC) wound classes and mesh repair with synthetic mesh or other type of meshes to treat complicated and contaminated VHR were considered for analysis. The main outcome was SSI incidence. Results Six studies compared mesh and suture repairs. No significant difference in SSI incidence was observed between patients with complicated VHR in the mesh and suture repair groups. Five studies analyzed mesh repair in patients by field contamination level. There was no significant difference between the use of mesh in clean-contaminated, contaminated and dirty field versus clean wound class. Moreover, there was no significant difference between the use of mesh in clean-contaminated and contaminated cases. Four studies compared mesh repair technique with synthetic mesh or other type of meshes were included. The incidence of SSI was significantly lower in the synthetic mesh group. Conclusions The use of mesh repair in the management of complicated VHR compared to suture repair is not associated with an increased incidence of SSI even in potentially contaminated fields.

Risks and Prevention of Surgical Site Infection After Hernia Mesh Repair and the Predictive Utility of ACS-NSQIP

“…15,36 The choice of permanent synthetic mesh over biologic or biosynthetic mesh in a contaminated/dirty wound, or as a replacement mesh in an infected hernia wound is controversial. 34,37 Indeed, the ability of biological mesh to resist infection as compared to synthetic mesh was recently challenged in an in vitro experiment investigating inoculation of mesh with a single species of MRSA. It was found human dermal collagen mesh (Bard® Davol Inc., Cranston, RI) was significantly more prone to develop larger and more extensive MRSA biofilms with greater substratum penetration than absorbable synthetic polyglactin 910 woven mesh, or permanent synthetic polypropylene mesh (Bard® Davol Inc., Cranston, RI).…”

“…9,11,40,41 Some surgical societies including the WSES and the Ventral Hernia Working Group advocate the use of simple suture or biological mesh in contaminated/dirty VHR cases. However, this approach has not been shown to be superior to macroporous polypropylene VHR with respect to SSI, surgical site occurrence (SSO), unplanned re-operation, cost or hernia recurrence in recent systematic reviews 11,37,40,41 (Fig. 3).…”

“…This is important when resources are limited, as the cost of a single biological mesh can be equivalent to 100 permanent synthetic meshes. 37…”

Colostomy Reversal following Hartmann’s Procedure: The Importance of Timing in Short- and Long-Term Complications: A Retrospective Multicentric Study

“…Hypothetically, the solution to the “hernia” problem on the occasion of early restoration could be overcome with the use of prosthetic material to reinforce the site of the new laparotomy, or the previous stoma. Despite the use of traditional prosthetic material being controversial in literature [ 37 , 38 ], a growing body of evidence supports the use of an abdominal wall reinforcement at the time of different elective and emergency colorectal procedures, to prevent ventral hernia in high-risk patients [ 39 , 40 , 41 , 42 , 43 ]. Besides, the appeal of bio-resorbable materials in prophylactic mesh augmentation in this kind of surgery, there is insufficient evidence to support their use in primary ventral hernia prevention.…”

Evaluating the Role of Glove Changing Before Mesh Application During Herniorrhaphy Surgery to Reduce Surgical Site Infections

“…Another part of the problem that deals with SSI is the use of prosthetic meshes. Although meshes reduce the risk of hernia recurrence, they provide a surface for opportunistic pathogens to form a biofilm (2,15). Many efforts have been made to provide materials that lower the rate of SSI, such as silver and chlorhexidine-impregnated products or recently proposed polypropylene meshes.…”