Welcome to the AHS 2020 ePoster Session. Please scroll down to view all of the submitted posters or press Control-F to search. To view the poster and its abstract, click on the poster image. Many posters also have a brief audio introduction which can be played by going to the bottom of the poster screen.
P016: MESH FAILURE – ARE BACTERIAL BIOFILMS THE HIDDEN CULPRIT?
Paul Patiniott, Dr1; Anita Jacombs, Dr2; Alex Karatassas, Dr1; Guy Maddern, Professor1; Bernd Klosterhalfen, Professor3; 1The University of Adelaide; 2Macquarie University; 3Institute of Pathology, Dueren, Germany
Introduction: The impact of bacterial biofilms and effective mesh porosity on hernia repair are unstudied topics to date. Having major implications on many non-hernia disease conditions, bacterial biofilm infection and its possible reduction of mesh porosity and subsequent limitation of mesh-tissue integration may present a plausible explanation for delayed “mesh infection”, chronic seroma, chronic pain, and failure of hernia repair. There is evidence in the literature that directly implicates biofilm involvement in chronic inflammation and peri-implant tissue fibrosis resulting in the failure of several surgical implants including breast, vascular and orthopedic joint. This is a concept should be extended to hernia mesh as a potential mechanism for mesh failure and hernia recurrence. Currently, there have been minimal studies into biofilm disease of hernia mesh, it’s causative bacteria and the sequelae of this type of infection.
Methods: Thirty deidentified paraffin-embedded tissue sections from explanted groin hernia mesh in patients with chronic pain, were supplied to the research team courtesy of Professor Bernd Klosterhalfen, Aachen, Germany. Each specimen was sectioned into duplicate into 5 µm slices using a microtome and placed on a negatively charged microscopy slides. The specimens were heated to 600 C in a heat bath, deparaffinized in xylene and rehydrated in serial ethanol and phosphate-buffered saline before fixation. Each mesh specimen was stained with a peptide nucleic acid fluorescence in situ hybridization (PNA FISH) probes from AdvanDx (OpGen® Denmark) specific for Staphylococcus aureus and Staphylococcus epidermidis rRNA using the manufacture’s protocol. The slides were mounted and imaged with an Olympus FV3000 Laser Scanning Confocal Microscope to analyze and for the detection of bacterial biofilm in the explanted hernia mesh-tissue. The resulting images were independently reviewed by consultant clinical microbiologist and the results were compared and found to be similar The findings were subsequently correlated with the clinical and mesh information.
Results: Explanted mesh tissue specimens from thirty (30) patients were analyzed in total. Each specimen was a polypropylene-based mesh, from various manufacturers, explanted from groins related to previous open or laparoscopic inguinal hernia repairs. The earliest mesh was explanted at 8 months, the latest at 72 months with an average explant time of 30 months post-inguinal hernia repair. The most common indication for mesh removal was chronic pain followed by hernia recurrence and shrinkage respectively. Bacterial biofilm was identified in the majority of specimens and these results along with the incidence of S. aureus biofilms and S. epidermidis will be presented.
Conclusion: There was confocal microscopic evidence of bacterial biofilm identified in the majority of the specimens from mesh explanted from previous inguinal hernia repairs. Late mesh complications are uncommon but result in significant morbidity, hence the importance of further investigating the role of biofilms in hernia mesh cannot be overstated. Further investigation is required to better understand the role of bacterial biofilm infection of hernia mesh, the bacteria causing these infections and the clinical sequelae and complications of bacterial biofilm mesh disease.
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