Minimally invasive mesh salvaging technique on treatment of hernia mesh infection: A case series

Introduction: The aim of the presentation is to demonstrate a new conservative approach for the salvage treatment of the infected hernia mesh. Methods: Three patients with polypropylene mesh infection following an open umbilical and incisional hernia repair performed by placing the mesh in the onlay position are presented. The infection manifested itself with a systemic inflammatory response and an infected fluid collection surrounding the mesh. All patients were treated conservatively by a minimally invasive technique according to the stepwise protocol. Results: An effective, rapid response to the conservative treatment was observed. A total of five to six procedures were necessary in a period of up to twenty days. Mesh salvage was achieved, and the long-term outcome demonstrates neither the recurrence of infection nor hernia. An enclosed space at the infection site is the main precondition for providing a sufficient concentration of the antiseptic for a long enough time to act effectively at the infection site. The fast killing effect on the mesh infection and a good long-term outcome in all presented patients prove that this technique is superior to the the current techniques in appropriately selected patients from the point of treatment duration. Conclusion: An effective mesh salvaging conservative treatment is possible when the infection manifests itself as an infected fluid collection surrounding the monofilament, large-pore polypropylene mesh and should be the first-line option. Open surgical approach should be reserved as a second-line option if the first fails.