ObjectiveTo summarize the method and experience in surgical treatment for mesh infection after prosthetic patch repair of ventral hernia. MethodsThe clinical data of 16 patients with mesh infection after ventral hernia repair accepted surgical treatment in our department from June 2007 to May 2010 were analyzed retrospectively. There were 10 males and 6 females, the age range from 24 to 73 years with an average 45.2 years. The patients with mesh infection included 11 cases of infection after incisional hernia repair, 4 cases of infection after abdominal wall defects repair caused by abdominal wall tumor resection, 1 mesh infection combine with urinary fistula caused by parastomal hernia of ileal neobladder repaired by using prosthetic patch. Clinical manifestation included mesh exposion, abscess, chronic sinus, and enterocutaneous fistula. All patients accepted local treatment of change dressing by primary operative surgeon, but the wounds didn’t heal about 3 to 24 months. Then the patients performed radical removal of infected mesh and abdominal wall reconstruction. ResultsAll patients accepted affected mesh removal successfully. Five patients performed abdominal wall reconstruction by using components separation technique. Four cases accepted abdominal wall repair by using polypropylene mesh. Five patients performed abdominal wall repair by using human acelluar dermal matrix. One case accepted change dressing and vacuum aspiration on the infected wound surface without reconstruction. And one case closed the wound immediately after infected mesh removal. The postoperative hospitalization time was 9 to 25 d (average 14 d). Thirteen patients recovered with primary wound healing. The other 3 cases recovered with second healing by local change dressing. All patients were followed up from 6 to 34 months (average 22 months), no abdominal wall hernia recurrence occurred. ConclusionsIt is very difficult to deal with mesh infection after prosthetic patch repair of abdominal wall hernia or defect. The surgical treatment should be done according to specific condition of each individual so as to acquire satisfied results.
Objective To summarize the experiences and methods on reoperation of recurrent incisional hernia after mesh repair with prosthetic patch. Methods Sixteen patients who got reoperation from January 2007 to December 2010 because of recurrent incisional hernia after mesh repair were analyzed retrospectively. Results All patients received prosthetic patch repair for reoperation. Thirteen patients received new mesh repair accompanied with old mesh removal, repair conducted by suturing new mesh with old mesh together in two patients, and repair performed by new mesh overlapping the old mesh in one patient. All patients recovered with primary wound healing. Fluid upon the mesh occurred in 3 patients and cured by percutaneous puncture and pressure dressing. Postoperative hospital stay was 7 to 16 days and the average 9 days. The drainage was removed 2 to 7 days after operation and the average was 4 days. All the 16 patients were followed up. And during a follow-up range of 5 to 36 months and the average 20 months, there was slight foreign body sensation in one patient, no chronic pain in wound area occurred. And no abdominal wall hernia recurrence occurred. Conclusions Reoperation of recurrent incisional hernia after mesh repair need to consider the recurrent position, material of the previous mesh, and the previous surgical methods, and should select appropriate prosthetic patch and surgical procedure, then could gain satisfied results.
Objective To summarize the surgical technique and curative effect of laparoscopic repair for suprapubic incisional hernia using composite patch. Methods The clinical data of 25 cases performed laparoscopic repair of suprapubic incisional hernia using composite patch from March 2007 to October 2010 were reviewed retrospectively. There were 13 males and 12 females， and aged 35-83 years （median age was 52 years）. Among them 2 patients were recurrences. The distance between the lower margin of hernia defect and pubic arc was less than 5 cm. The composite patch was fixed to the abdominal wall using spiral tacks （Protack） in direct vision. The lower margin of the patch was lower to the pubic arc in 2 cm， and to be fixed to the pubic arc and bilateral pectineal ligament， and it should be extended. Results Laparoscopic repair were successfully performed in all patients without convert to open repair. The max diameter of the hernia ring was 6.1-12.5cm and the average was 9.5 cm. The average operating time was 128 min （ranging from 90 to 180 min）. And the total complication rate was 28% （7/25）， including bladder damage during operation in 1 case， wound seroma upon the patch in 4 cases and cured by aspiration， pain in the operative area and disappeared within one month without intervention in 1 case. Twenty-two patients were followed-up with a follow-up rate of 88%. During a follow-up range of 6-48 months（average 30 months）， one case recurrence occurred in 2 months after the repair with the recurrent rate of 4%. Conclusions Laparoscopic repair of suprapubic incisional hernia is a safe and feasible technique， and the patch should cover and exceed the margin of the defect for 5 cm in all direction. The lower margin of the patch should be fixed to the bilateral pectineal ligament so as to strengthen the fix， and lower the recurrence rate.
Objective Mesh infection may occur after incisional hernia repair using prosthetic mesh. Preparation of antibiotics-bonded meshes to prevent infection is one of the solutions. To evaluate the anti-infection effect of polypropylene mesh bonded norvancomycin slow-release microsphere by preparing the rat model of incisional hernia repair contaminatedwith Staphylococcus aureus. Methods The norvancomycin slow-release microspheres were prepared by emulsion and solvent evaporation method and they were bonded to polypropylene mesh (50 mg/mesh). The appearance of the microspheres was observed using scanning electronic microscope (SEM). The content of norvancomycin in microspheres and the release rate of the norvancomycin in norvancomycin-bonded polypropylene mesh were detected using high performance l iquid chromatography method. The rat models of incisional hernia were developed in 40 healthy Sprague Dawley rats, aged 10-11 weeks and weighing 200-250 g. The rats were divided randomly into the experimental group (norvancomycin-bonded polypropylene mesh repair, n=20) and the control group (polypropylene mesh repair, n=20). And then the mesh was contaminated with Staphylococcus aureus. The wound heal ing was observed after operation. At 3 weeks after operation, the mesh and the tissue around the mesh were harvested to perform histological observation and to classify the inflammatory reaction degree. Results The norvancomycin microsphere had integrated appearance and smooth surface with uniform particle diameter, 64% of particlediameter at 60 to 100 μm, and the loading-capacity of norvancomycin was 19.79%. The norvancomycin-bonded polypropylene patch had well-distributed surface and the loading-capacity of norvancomycin was (7.90 ± 0.85) mg/cm2. The release time of norvancomycin in vitro could last above 28 days and the accumulative release rate was 72.6%. The rats of 2 groups all survived to experiment completion. Wound infection occurred in 2 rats of the experimental group (10%) and 20 rats of the control group (100%), showing significant difference (χ2=32.727 3, P=0.000 0). The inflammatory reaction in experimental group was not obvious, grade I in 16 rats and grade II in 4 rats, and numerous inflammatory cell infiltration occurred in the control group, grade II in 3 rats and grade III in 17 rats, showing significant difference (Z=32.314, P=0.000). Conclusion The polypropylene mesh bonded norvancomycin slow-release microsphere has definite anti-infection effect in rat model of incisional hernia repair contaminated by Staphylococcus aureus.