Wound infection following repair of abdominal wall hernia
- Anne T Mancino, MD
Anne T Mancino, MD
- Associate Professor of Surgery
- University of Arkansas of Medical Sciences
- Tahaniyat Lalani, MBBS, MHS
Tahaniyat Lalani, MBBS, MHS
- Assistant Professor
- Uniformed Services University of the Health Sciences
- Section Editors
- Michael Rosen, MD
Michael Rosen, MD
- Section Editor — Hernia Surgery
- Professor of Surgery
- Cleveland Clinic Foundation
- Daniel J Sexton, MD
Daniel J Sexton, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — Bacterial Infections
- Professor of Medicine
- Duke University Medical Center
The repair of an abdominal wall hernia is a generally clean procedure with a low risk of infectious complications. However, when wound infections do occur following a hernia repair, they can be associated with hernia recurrence, mesh infections, and systemic complications [1,2].
Abdominal wall hernia repairs can be divided into two broad categories:
●Ventral hernia repair – includes incisional, ventral, epigastric, spigelian, peristomal, and umbilical hernias. (See "Overview of abdominal wall hernias in adults".)
●Groin hernia repairs – includes inguinal and femoral hernias. (See "Classification, clinical features and diagnosis of inguinal and femoral hernias in adults".)
Risk factors for and strategies to reduce the risk of infection after abdominal wall hernia repair are reviewed here. An overview of antibiotic prophylaxis and other control measures to prevent surgical site infection are discussed elsewhere. (See "Antimicrobial prophylaxis for prevention of surgical site infection in adults" and "Adjunctive measures for prevention of surgical site infection in adults".)
- Finan KR, Vick CC, Kiefe CI, et al. Predictors of wound infection in ventral hernia repair. Am J Surg 2005; 190:676.
- Luijendijk RW, Hop WC, van den Tol MP, et al. A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med 2000; 343:392.
- Wang J, Ji G, Yang Z, et al. Prospective randomized, double-blind, placebo controlled trial to evaluate infection prevention in adult patients after tension-free inguinal hernia repair. Int J Clin Pharmacol Ther 2013; 51:924.
- Pokorny H, Klingler A, Schmid T, et al. Recurrence and complications after laparoscopic versus open inguinal hernia repair: results of a prospective randomized multicenter trial. Hernia 2008; 12:385.
- Gravante G, Venditti D, Filingeri V. The role of single-shot antibiotic prophylaxis in inguinal hernia repair: a meta-analysis approach of 4336 patients. Ann Surg 2008; 248:496.
- Wake, B. L., McCormack, K., Fraser, C., Vale, L., Perez, J., and Grant, A. M. Transabdominal pre-peritoneal (TAPP) vs totally extraperitoneal (TEP) laparoscopic techniques for inguinal hernia repair. Cochrane.Database.Syst.Rev. 1-25-2005;CD004703.
- McCormack K, Wake BL, Fraser C, et al. Transabdominal pre-peritoneal (TAPP) versus totally extraperitoneal (TEP) laparoscopic techniques for inguinal hernia repair: a systematic review. Hernia 2005; 9:109.
- Legnani GL, Rasini M, Pastori S, Sarli D. Laparoscopic trans-peritoneal hernioplasty (TAPP) for the acute management of strangulated inguino-crural hernias: a report of nine cases. Hernia 2008; 12:185.
- Neumayer L, Giobbie-Hurder A, Jonasson O, et al. Open mesh versus laparoscopic mesh repair of inguinal hernia. N Engl J Med 2004; 350:1819.
- National Nosocomial Infections Surveillance System. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004; 32:470.
- Grant AM, EU Hernia Trialists Collaboration. Open mesh versus non-mesh repair of groin hernia: meta-analysis of randomised trials based on individual patient data [corrected]. Hernia 2002; 6:130.
- McCormack, K, Scott, N, Go, PM, Ross, SJ, Grant, A. Collaboration the EU Hernia Trialists. Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database of Systematic Reviews 2003, No.: CD001785. DOI: 10.1002/14651858.CD001785.
- Witkowski, P, Pirski, M, I, Adamonis, et al. Mesh plug versus Bassini operation: a randomized prospective study. Hernia 2000; 4:305.
- Amid, PK. Classification of biomaterials and their related complications in abdominal wall hernia surgery. Hernia 1997; 1:15.
- Petersen S, Henke G, Zimmermann L, et al. Ventral rectus fascia closure on top of mesh hernia repair in the sublay technique. Plast Reconstr Surg 2004; 114:1754.
- den Hartog D, Dur AHM, Tuinebreijer WE, Kreis RW. Open surgical procedures for incisional hernias. Cochrane Database of Systematic Reviews 2008, No.: CD006438. DOI: 10.1002/14651858.CD006438.pub2.
- Korenkov M, Sauerland S, Arndt M, et al. Randomized clinical trial of suture repair, polypropylene mesh or autodermal hernioplasty for incisional hernia. Br J Surg 2002; 89:50.
- Dur AH, den Hartog D, Tuinebreijer WE, et al. Low recurrence rate of a two-layered closure repair for primary and recurrent midline incisional hernia without mesh. Hernia 2009; 13:421.
- Pierce RA, Spitler JA, Frisella MM, et al. Pooled data analysis of laparoscopic vs. open ventral hernia repair: 14 years of patient data accrual. Surg Endosc 2007; 21:378.
- Carlson MA, Frantzides CT, Shostrom VK, Laguna LE. Minimally invasive ventral herniorrhaphy: an analysis of 6,266 published cases. Hernia 2008; 12:9.
- Itani KM, Hur K, Kim LT, et al. Comparison of laparoscopic and open repair with mesh for the treatment of ventral incisional hernia: a randomized trial. Arch Surg 2010; 145:322.
- Burger JW, Luijendijk RW, Hop WC, et al. Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg 2004; 240:578.
- Forbes SS, Eskicioglu C, McLeod RS, Okrainec A. Meta-analysis of randomized controlled trials comparing open and laparoscopic ventral and incisional hernia repair with mesh. Br J Surg 2009; 96:851.
- Mavros MN, Athanasiou S, Alexiou VG, et al. Risk factors for mesh-related infections after hernia repair surgery: a meta-analysis of cohort studies. World J Surg 2011; 35:2389.
- Rosemar A, Angerås U, Rosengren A, Nordin P. Effect of body mass index on groin hernia surgery. Ann Surg 2010; 252:397.
- Ríos A, Rodríguez JM, Munitiz V, et al. Antibiotic prophylaxis in incisional hernia repair using a prosthesis. Hernia 2001; 5:148.
- White TJ, Santos MC, Thompson JS. Factors affecting wound complications in repair of ventral hernias. Am Surg 1998; 64:276.
- Stremitzer S, Bachleitner-Hofmann T, Gradl B, et al. Mesh graft infection following abdominal hernia repair: risk factor evaluation and strategies of mesh graft preservation. A retrospective analysis of 476 operations. World J Surg 2010; 34:1702.
- Deysine M. Pathophysiology, prevention, and management of prosthetic infections in hernia surgery. Surg Clin North Am 1998; 78:1105.
- Ousley J, Baucom RB, Stewart MK, et al. Previous Methicillin-Resistant Staphylococcus aureus Infection Independent of Body Site Increases Odds of Surgical Site Infection after Ventral Hernia Repair. J Am Coll Surg 2015; 221:470.
- Brown RH, Subramanian A, Hwang CS, et al. Comparison of infectious complications with synthetic mesh in ventral hernia repair. Am J Surg 2013; 205:182.
- Cobb WS, Kercher KW, Heniford BT. Laparoscopic repair of incisional hernias. Surg Clin North Am 2005; 85:91.
- Perrone JM, Soper NJ, Eagon JC, et al. Perioperative outcomes and complications of laparoscopic ventral hernia repair. Surgery 2005; 138:708.
- Nguyen MT, Berger RL, Hicks SC, et al. Comparison of outcomes of synthetic mesh vs suture repair of elective primary ventral herniorrhaphy: a systematic review and meta-analysis. JAMA Surg 2014; 149:415.
- Brown CN, Finch JG. Which mesh for hernia repair? Ann R Coll Surg Engl 2010; 92:272.
- Smart NJ, Bryan N, Hunt JA, Daniels IR. Porcine dermis implants in soft-tissue reconstruction: current status. Biologics 2014; 8:83.
- Harth KC, Broome AM, Jacobs MR, et al. Bacterial clearance of biologic grafts used in hernia repair: an experimental study. Surg Endosc 2011; 25:2224.
- Alaedeen DI, Lipman J, Medalie D, Rosen MJ. The single-staged approach to the surgical management of abdominal wall hernias in contaminated fields. Hernia 2007; 11:41.
- Candage R, Jones K, Luchette FA, et al. Use of human acellular dermal matrix for hernia repair: friend or foe? Surgery 2008; 144:703.
- Leber GE, Garb JL, Alexander AI, Reed WP. Long-term complications associated with prosthetic repair of incisional hernias. Arch Surg 1998; 133:378.
- Martin DF, Williams RF, Mulrooney T, Voeller GR. Ventralex mesh in umbilical/epigastric hernia repairs: clinical outcomes and complications. Hernia 2008; 12:379.
- Diaz JJ Jr, Conquest AM, Ferzoco SJ, et al. Multi-institutional experience using human acellular dermal matrix for ventral hernia repair in a compromised surgical field. Arch Surg 2009; 144:209.
- Ventral Hernia Working Group, Breuing K, Butler CE, et al. Incisional ventral hernias: review of the literature and recommendations regarding the grading and technique of repair. Surgery 2010; 148:544.
- Rosen MJ, Denoto G, Itani KM, et al. Evaluation of surgical outcomes of retro-rectus versus intraperitoneal reinforcement with bio-prosthetic mesh in the repair of contaminated ventral hernias. Hernia 2013; 17:31.
- Dalenbäck J, Andersson C, Anesten B, et al. Prolene Hernia System, Lichtenstein mesh and plug-and-patch for primary inguinal hernia repair: 3-year outcome of a prospective randomised controlled trial. The BOOP study: bi-layer and connector, on-lay, and on-lay with plug for inguinal hernia repair. Hernia 2009; 13:121.
- Carbonell AM, Cobb WS. Safety of prosthetic mesh hernia repair in contaminated fields. Surg Clin North Am 2013; 93:1227.
- Geisler DJ, Reilly JC, Vaughan SG, et al. Safety and outcome of use of nonabsorbable mesh for repair of fascial defects in the presence of open bowel. Dis Colon Rectum 2003; 46:1118.
- Birolini C, Utiyama EM, Rodrigues AJ Jr, Birolini D. Elective colonic operation and prosthetic repair of incisional hernia: does contamination contraindicate abdominal wall prosthesis use? J Am Coll Surg 2000; 191:366.
- Atila K, Guler S, Inal A, et al. Prosthetic repair of acutely incarcerated groin hernias: a prospective clinical observational cohort study. Langenbecks Arch Surg 2010; 395:563.
- Papaziogas B, Lazaridis Ch, Makris J, et al. Tension-free repair versus modified Bassini technique (Andrews technique) for strangulated inguinal hernia: a comparative study. Hernia 2005; 9:156.
- Abdel-Baki NA, Bessa SS, Abdel-Razek AH. Comparison of prosthetic mesh repair and tissue repair in the emergency management of incarcerated para-umbilical hernia: a prospective randomized study. Hernia 2007; 11:163.
- Carbonell AM, Criss CN, Cobb WS, et al. Outcomes of synthetic mesh in contaminated ventral hernia repairs. J Am Coll Surg 2013; 217:991.
- Taylor SG, O'Dwyer PJ. Chronic groin sepsis following tension-free inguinal hernioplasty. Br J Surg 1999; 86:562.
- Akyol C, Kocaay F, Orozakunov E, et al. Outcome of the patients with chronic mesh infection following open inguinal hernia repair. J Korean Surg Soc 2013; 84:287.
- Fawole AS, Chaparala RP, Ambrose NS. Fate of the inguinal hernia following removal of infected prosthetic mesh. Hernia 2006; 10:58.
- Paton BL, Novitsky YW, Zerey M, et al. Management of infections of polytetrafluoroethylene-based mesh. Surg Infect (Larchmt) 2007; 8:337.
- Bratzler DW, Dellinger EP, Olsen KM, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Surg Infect (Larchmt) 2013; 14:73.
- Falagas ME, Kasiakou SK. Mesh-related infections after hernia repair surgery. Clin Microbiol Infect 2005; 11:3.
- Nolla-Salas J, Torres-Rodríguez JM, Grau S, et al. Successful treatment with liposomal amphotericin B of an intraabdomianl abscess due to Candida norvegensis associated with a Gore-Tex mesh infection. Scand J Infect Dis 2000; 32:560.
- Matthews MR, Caruso DM, Tsujimura RB, et al. Ventral hernia synthetic mesh repair infected by Mycobacterium fortuitum. Am Surg 1999; 65:1035.
- Costerton JW, Stewart PS, Greenberg EP. Bacterial biofilms: a common cause of persistent infections. Science 1999; 284:1318.
- Donlan RM. Biofilm formation: a clinically relevant microbiological process. Clin Infect Dis 2001; 33:1387.
- Vuong C, Gerke C, Somerville GA, et al. Quorum-sensing control of biofilm factors in Staphylococcus epidermidis. J Infect Dis 2003; 188:706.
- Gilbert AI, Felton LL. Infection in inguinal hernia repair considering biomaterials and antibiotics. Surg Gynecol Obstet 1993; 177:126.
- Kuo YC, Mondschein JI, Soulen MC, et al. Drainage of collections associated with hernia mesh: is it worthwhile? J Vasc Interv Radiol 2010; 21:362.
- Cingi A, Manukyan MN, Güllüoğlu BM, et al. Use of resterilized polypropylene mesh in inguinal hernia repair: a prospective, randomized study. J Am Coll Surg 2005; 201:834.
- Terzi C, Kiliç D, Unek T, et al. Single-dose oral ciprofloxacin compared with single-dose intravenous cefazolin for prophylaxis in inguinal hernia repair: a controlled randomized clinical study. J Hosp Infect 2005; 60:340.
- Bittner R, Arregui ME, Bisgaard T, et al. Guidelines for laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia [International Endohernia Society (IEHS)]. Surg Endosc 2011; 25:2773.
- Salvati EA, Chekofsky KM, Brause BD, Wilson PD Jr. Reimplantation in infection: a 12-year experience. Clin Orthop Relat Res 1982; :62.
- Ismail W, Agrawal A, Zia MI. Fate of chronically infected onlay mesh in groin wound. Hernia 2002; 6:79.
- Alston D, Parnell S, Hoonjan B, et al. Conservative management of an infected laparoscopic hernia mesh: A case study. Int J Surg Case Rep 2013; 4:1035.
- Aguilar B, Chapital AB, Madura JA 2nd, Harold KL. Conservative management of mesh-site infection in hernia repair. J Laparoendosc Adv Surg Tech A 2010; 20:249.
- Trunzo JA, Ponsky JL, Jin J, et al. A novel approach for salvaging infected prosthetic mesh after ventral hernia repair. Hernia 2009; 13:545.
- EPIDEMIOLOGY AND RISK FACTORS
- Hernia location
- Clinical and intraoperative factors
- Open versus laparoscopic hernia repair
- Mesh-related factors
- - Non-mesh versus mesh repairs
- - Nonabsorbable versus absorbable mesh
- - Location of mesh placement
- - Complicated hernia repair
- Placement of drains
- CLINICAL FEATURES AND DIAGNOSIS
- Diagnosis of postoperative wound infection
- Wound/fluid cultures
- - Microbiology
- DIFFERENTIAL DIAGNOSIS
- Superficial wound infection
- Deep wound/mesh infection
- MEASURES TO PREVENT RECURRENT INFECTION
- SUMMARY AND RECOMMENDATIONS