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.
P040: EVALUATING SURGICAL OUTCOMES IN CHRONIC MESH INFECTIONS TREATED WITH PARTIAL VERSUS TOTAL MESH EXCISION
Viktor V Fedorov, DO; Justin D Faulkner, MD; Jordan A Bilezikian, MD; William W Hope, MD, FACS; New Hanover Regional Medical Center
Introduction: Mesh infections can be one of the most problematic complications following hernia repairs, but can range in severity from a localized, chronic draining sinus to involving the majority of the mesh. While current guidelines favor total mesh explantation with infectious compromise of the mesh, we evaluated the viability of partial mesh excisions on a select group of patients with the hypothesis that it would be sufficient in specific cases of localized mesh infections.
Methods: We performed a retrospective analysis in all patients who met inclusion criteria from 8/2010 to 4/2020 who had an operative intervention for a chronic mesh infection after ventral hernia repair, and followed their postoperative course. We analyzed the complication rate of performing partial mesh excisions rather than total mesh excisions. We documented demographics, the specific hernia complication (chronic draining sinus from a stitch abscess versus total mesh compromise), whether a partial or total mesh excision was performed, and whether the patient had any postoperative complications (infection or hernia recurrence) depending on the type of mesh excision performed.
Results: Twenty patients met inclusion criteria and were included in the study. 70% were female, 85% were Caucasian, and 15% were African-American. The average age was 63 with a range of 33 to 76. A total of 4 patients (20%) had a post-operative complication. Nine patients (45%) underwent a partial mesh excision and 3 (33%) of those failed due to recurrence of mesh infection as compared to 9 patients (45%) who underwent total mesh excision with only 1 (11%) failure due to hernia recurrence. Two patients (10%) underwent an incision and drainage and washout without mesh excision for an infected hematoma and seroma overlying their mesh and had no post-operative complications.
Of note, 10 patients (50%) were noted to have a chronic draining sinus as their initial presentation and had only a localized mesh infection. Eight (80%) of those patients underwent a partial mesh excision and 2 of the 8 patients (25%) had postoperative complications. Alternately, 2 patients (10%) underwent a total mesh excision and had no post-operative complications.
There was no 30-day or one-year mortality in any of the patients.
Conclusion: This study demonstrated the viability of partial mesh excisions in select patient populations. While there were more post-operative complications documented with partial mesh excisions, there was no mortality increase. Further inquiry into this topic would be beneficial to the informed-consent process, especially if patients are presenting with small, localized mesh complications and are electing to avoid complex hernia repairs that would involve total mesh explantation. Further study is required to obtain an adequate sample size to draw conclusions with statistical significance.
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