No-Touch Technique of Mesh Placement in Ventral Hernia Repair: Minimizing Postoperative Mesh Infections

Abstract

Summary: Synthetic mesh is commonly used in ventral hernia repairs to reinforce the abdominal closure and minimize hernia recurrence rates. However, the use of synthetic mesh is associated with certain risks, most notably infection requiring explantation. This study sought to evaluate the use of a “no-touch” technique with antibiotic solution during synthetic mesh placement in ventral hernia repairs and its impact on complication/infection rates. The authors retrospectively reviewed a prospectively maintained database of patients undergoing abdominal wall reconstruction with synthetic mesh from 2013 to 2018 by a single surgeon with a minimum 1-year follow-up. Data collected included demographic data, medical comorbidities, hernia history, and the type of antibiotics used in the no-touch technique. Complications were stratified into short-term (<30 days), medium-term (30 to 90 days), and long-term (91 to 365 days) complications. Results were compared to previously published rates in the literature. Eighty-eight patients met inclusion criteria. Fourteen patients (15.9 percent) experienced postoperative complications (two patients had multiple complications); six of these patients (6.8 percent) were readmitted to the hospital for management. Subsequently, three of the readmitted patients (3.4 percent) required reoperations related to abdominal infection and required removal of the synthetic mesh. A total of 16 complication events occurred in the cohort: 13 short-term complications (81.3 percent), three medium-term complications (18.7 percent), and zero long-term complications. The authors conclude that the no-touch technique for mesh placement in ventral hernia repairs appears to be efficacious in minimizing infectious complications with mesh placement, although further prospective studies are required to further define this relationship. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

The European Hernia Society Prehabilitation Project: A Systematic Review of Intra-Operative Prevention Strategies for Surgical Site Occurrences in Ventral Hernia Surgery

“…Regarding mesh related morbidity, mesh handling might be of importance. Schneeberger et al performed a demographic study in 88 patients undergoing ventral hernia repair using a “no-touch” technique during synthetic mesh placement ( 21 ). The authors retrospectively reviewed a prospectively maintained database of patients undergoing abdominal wall reconstruction with synthetic mesh from 2013 to 2018 by a single surgeon with a minimum 1-year follow-up.…”

“…When considering the intra-operative setting very little evidence could be identified regarding SSI prevention. An intraoperative no touch technique was proposed by Schneeberger et al, but there were some clear concerns regarding this study (21). Firstly, it is a non-comparative study, designed as a pilot to evaluate the no-touch technique as a benchmark for future prospective studies.…”

Prosthetic meshes for hernia repair: State of art, classification, biomaterials, antimicrobial approaches, and fabrication methods

“…Prosthetic materials for hernia repair often present infection by bacteria on the material surface that results in failure of the implanted meshes. [203][204][205][206][207] Two examples of chronic bacterial infections (biofilm) are shown in Figure 2. S. aureus (MRSA), 210 involved in up to 63% of surgical site meshrelated infections, [211][212][213] being methicillin-resistant.…”

The Interplay of ECM-Based Graft Materials and Mechanisms of Tissue Remodeling

“…Even though synthetic mesh materials continue to be favored in general surgical practice because of their versatility and low cost, they remain susceptible to chemical degradation over time, can create physical tissue erosion due to mismatches in their mechanical properties with the surrounding tissues, and may undergo encapsulation following placement because the body views them as foreign materials [1]. Of critical importance in many applications, synthetics can provide a nidus for microorganism growth; therefore, if they become infected when in the body, they typically need to be removed [2].…”