Abdominal Wall Mesh Infections

  • K. M. Coakley
  • B. T. Heniford
  • V. A. Augenstein


While mesh implantation significantly reduces hernia recurrence, infection of the mesh is one of the most dreaded and challenging conditions in abdominal wall reconstruction. With no available national database to track each mesh recipient’s outcome, the true incidence of mesh infection is difficult to determine and likely underestimated. With the prevalence of synthetic materials used, the number of patients who will suffer such infections is likely to increase. Currently, there is no independent database tracking mesh-related complications, no mandate to follow patients for any set amount of time, and no guidelines regarding what type of mesh to use and when. This chapter focuses on mesh infections following ventral and incisional hernia repair—incidence, presentation, risk factors, microbiome, and treatment.


  1. 1.
    Poulose BK, et al. Epidemiology and cost of ventral hernia repair: making the case for hernia research. Hernia. 2012;16(2):179–83.CrossRefGoogle Scholar
  2. 2.
    Sauerland S, et al. Laparoscopic versus open surgical techniques for ventral or incisional hernia repair. Cochrane Database Syst Rev. 2011;3:CD007781.Google Scholar
  3. 3.
    Merkow RP, et al. Underlying reasons associated with hospital readmission following surgery in the United States. JAMA. 2015;313(5):483–95.CrossRefGoogle Scholar
  4. 4.
    Zannis J, et al. Outcome study of the surgical management of panniculitis. Ann Plast Surg. 2012;68(2):194–7.CrossRefGoogle Scholar
  5. 5.
    Itani KM, et al. Comparison of laparoscopic and open repair with mesh for the treatment of ventral incisional hernia: a randomized trial. Arch Surg. 2010;145(4):322–8; discussion 328.CrossRefGoogle Scholar
  6. 6.
    Kaafarani HM, et al. Predictors of surgical site infection in laparoscopic and open ventral incisional herniorrhaphy. J Surg Res. 2010;163(2):229–34.CrossRefGoogle Scholar
  7. 7.
    Saxe A, et al. Simultaneous panniculectomy and ventral hernia repair following weight reduction after gastric bypass surgery: is it safe? Obes Surg. 2008;18(2):192–5; discussion 196.CrossRefGoogle Scholar
  8. 8.
    Albright E, et al. The component separation technique for hernia repair: a comparison of open and endoscopic techniques. Am Surg. 2011;77(7):839–43.PubMedGoogle Scholar
  9. 9.
    Mazzocchi M, et al. Component separation technique and panniculectomy for repair of incisional hernia. Am J Surg. 2010;201:776–83.CrossRefGoogle Scholar
  10. 10.
    Zemlyak AY, et al. Comparative study of wound complications: isolated panniculectomy versus panniculectomy combined with ventral hernia repair. J Surg Res. 2012;177(2):387–91.CrossRefGoogle Scholar
  11. 11.
    Hoer J, Fischer L, Schachtrupp A. Laparotomy closure and incisional hernia prevention – what are the surgical requirements? Zentralbl Chir. 2011;136(1):42–9.CrossRefGoogle Scholar
  12. 12.
    Korenkov M, et al. Incisional hernia repair in Germany at the crossroads: a comparison of two hospital surveys in 1995 and 2001. Zentralbl Chir. 2002;127(8):700–4; discussion 704-5.CrossRefGoogle Scholar
  13. 13.
    Luijendijk RW, et al. A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med. 2000;343(6):392–8.CrossRefGoogle Scholar
  14. 14.
    Burger JW, et al. Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg. 2004;240(4):578–83; discussion 583-5.PubMedPubMedCentralGoogle Scholar
  15. 15.
    Mathes T, Walgenbach M, Siegel R. Suture versus mesh repair in primary and incisional ventral hernias: a systematic review and meta-analysis. World J Surg. 2016;40(4):826–35.CrossRefGoogle Scholar
  16. 16.
    Groene SA, et al. Prospective, multi-institutional surgical and quality-of-life outcomes comparison of heavyweight, midweight, and lightweight mesh in open ventral hernia repair. Am J Surg. 2016;212(6):1054–62.CrossRefGoogle Scholar
  17. 17.
    Ventral Hernia Working Group, et al. Incisional ventral hernias: review of the literature and recommendations regarding the grading and technique of repair. Surgery. 2010;148(3):544–58.CrossRefGoogle Scholar
  18. 18.
    den Hartog D, et al. Open surgical procedures for incisional hernias. Cochrane Database Syst Rev. 2008;3:CD006438.Google Scholar
  19. 19.
    Funk LM, et al. Current national practice patterns for inpatient management of ventral abdominal wall hernia in the United States. Surg Endosc. 2013;27(11):4104–12.CrossRefGoogle Scholar
  20. 20.
    Finan KR, Kilgore ML, Hawn MT. Open suture versus mesh repair of primary incisional hernias: a cost-utility analysis. Hernia. 2009;13(2):173–82.CrossRefGoogle Scholar
  21. 21.
    Kokotovic D, Bisgaard T, Helgstrand F. Long-term recurrence and complications associated with elective incisional hernia repair. JAMA. 2016;316(15):1575–82.CrossRefGoogle Scholar
  22. 22.
    Wormer BA, et al. Ventral hernia repair in the western world: prospective international study demonstrates similar surgical outcomes found in Europe and USA. J Surg Res. 2013;179(2):238–9.CrossRefGoogle Scholar
  23. 23.
    Colavita PD, et al. Laparoscopic versus open hernia repair: outcomes and sociodemographic utilization results from the nationwide inpatient sample. Surg Endosc. 2013;27(1):109–17.CrossRefGoogle Scholar
  24. 24.
    Bliziotis IA, et al. Mesh-related infection after hernia repair: case report of an emerging type of foreign-body related infection. Infection. 2006;34(1):46–8.CrossRefGoogle Scholar
  25. 25.
    Hawn MT, et al. Predictors of mesh explantation after incisional hernia repair. Am J Surg. 2011;202(1):28–33.CrossRefGoogle Scholar
  26. 26.
    Hawn MT, et al. Long-term follow-up of technical outcomes for incisional hernia repair. J Am Coll Surg. 2010;210(5):648–55, 655–7.CrossRefGoogle Scholar
  27. 27.
    Cobb WS, et al. Infection risk of open placement of intraperitoneal composite mesh. Am Surg. 2009;75(9):762–7; discussion 767-8.PubMedGoogle Scholar
  28. 28.
    Cobb WS, et al. Open retromuscular mesh repair of complex incisional hernia: predictors of wound events and recurrence. J Am Coll Surg. 2015;220(4):606–13.CrossRefGoogle Scholar
  29. 29.
    Iqbal CW, et al. Long-term outcome of 254 complex incisional hernia repairs using the modified Rives-Stoppa technique. World J Surg. 2007;31(12):2398–404.CrossRefGoogle Scholar
  30. 30.
    Samee A, Adjepong S, Pattar J. Late onset mesh infection following laparoscopic inguinal hernia repair. BMJ Case Rep. 2011;2011:bcr0920114863.CrossRefGoogle Scholar
  31. 31.
    Petersen S, et al. Deep prosthesis infection in incisional hernia repair: predictive factors and clinical outcome. Eur J Surg. 2001;167(6):453–7.CrossRefGoogle Scholar
  32. 32.
    Carlson MA, et al. Minimally invasive ventral herniorrhaphy: an analysis of 6,266 published cases. Hernia. 2008;12(1):9–22.CrossRefGoogle Scholar
  33. 33.
    Sharma A, et al. Laparoscopic ventral/incisional hernia repair: a single centre experience of 1,242 patients over a period of 13 years. Hernia. 2011;15(2):131–9.CrossRefGoogle Scholar
  34. 34.
    Forbes SS, et al. Meta-analysis of randomized controlled trials comparing open and laparoscopic ventral and incisional hernia repair with mesh. Br J Surg. 2009;96(8):851–8.CrossRefGoogle Scholar
  35. 35.
    Tsereteli Z, et al. Laparoscopic ventral hernia repair (LVHR) in morbidly obese patients. Hernia. 2008;12(3):233–8.CrossRefGoogle Scholar
  36. 36.
    Oomen B. Do patients follow-up with their original surgeon when ventral hernia repairs (VHR) fail? American Hernia Society Annual Meeting; 2014.Google Scholar
  37. 37.
    Augenstein V, et al. Treatment of 161 consecutive synthetic mesh infections: can mesh be salvaged? In Affiliated Podium presentation at the Annual Meeting of the Americas Hernia Society, Washington, DC; 2015.Google Scholar
  38. 38.
    Kathju S, et al. Direct demonstration of bacterial biofilms on prosthetic mesh after ventral herniorrhaphy. Surg Infect. 2015;16(1):45–53.CrossRefGoogle Scholar
  39. 39.
    Zuvela M, et al. (99m)Tc-antigranulocyte antibody scintiscan versus computed tomography and ultrasound in the detection of silent mesh infection of the abdominal wall. Hell J Nucl Med. 2011;14(2):181–3.PubMedGoogle Scholar
  40. 40.
    Stremitzer S, 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(7):1702–9.CrossRefGoogle Scholar
  41. 41.
    Finan KR, et al. Predictors of wound infection in ventral hernia repair. Am J Surg. 2005;190(5):676–81.CrossRefGoogle Scholar
  42. 42.
    Sanchez VM, Abi-Haidar YE, Itani KM. Mesh infection in ventral incisional hernia repair: incidence, contributing factors, and treatment. Surg Infect. 2011;12(3):205–10.CrossRefGoogle Scholar
  43. 43.
    Martindale RG, Deveney CW. Preoperative risk reduction: strategies to optimize outcomes. Surg Clin North Am. 2013;93(5):1041–55.CrossRefGoogle Scholar
  44. 44.
    Cox TC, et al. The cost of preventable comorbidities on wound complications in open ventral hernia repair. J Surg Res. 2016;206(1):214–22.CrossRefGoogle Scholar
  45. 45.
    Evans KK, et al. Survey on ventral hernias: surgeon indications, contraindications, and management of large ventral hernias. Am Surg. 2012;78(4):388–97.PubMedGoogle Scholar
  46. 46.
    Simmons BP. Guideline for prevention of surgical wound infections. Am J Infect Control. 1983;11(4):133–43.CrossRefGoogle Scholar
  47. 47.
    Alexander JW, Solomkin JS, Edwards MJ. Updated recommendations for control of surgical site infections. Ann Surg. 2011;253(6):1082–93.CrossRefGoogle Scholar
  48. 48.
    Liang MK, et al. Abdominal reoperation and mesh explantation following open ventral hernia repair with mesh. Am J Surg. 2014;208(4):670–6.CrossRefGoogle Scholar
  49. 49.
    Augenstein VA, et al. CeDAR: Carolinas equation for determining associated risks. J Am Coll Surg. 2015;221(4):S65–6.CrossRefGoogle Scholar
  50. 50.
    Colavita PD, et al. External validation of a clinical prediction tool for wound infection in open ventral hernia repair (OVHR): 39th Annual International Congress of the European Hernia Society; 2017.Google Scholar
  51. 51.
    Basta MN, et al. Assessing the predictive accuracy of the American College of Surgeons National Surgical Quality Improvement Project Surgical Risk Calculator in open ventral hernia repair. Am J Surg. 2016;212(2):272–81.CrossRefGoogle Scholar
  52. 52.
    Liang MK, et al. External validation of the ventral hernia risk score for prediction of surgical site infections. Surg Infect. 2015;16(1):36–40.CrossRefGoogle Scholar
  53. 53.
    Smith CT, et al. Incidence and risk factors of incisional hernia formation following abdominal organ transplantation. Surg Endosc. 2015;29(2):398–404.CrossRefGoogle Scholar
  54. 54.
    Costerton JW, Stewart PS, Greenberg EP. Bacterial biofilms: a common cause of persistent infections. Science. 1999;284(5418):1318–22.CrossRefGoogle Scholar
  55. 55.
    Bueno-Lledo J, et al. Predictors of mesh infection and explantation after abdominal wall hernia repair. Am J Surg. 2017;213(1):50–7.CrossRefGoogle Scholar
  56. 56.
    Huntington C, et al. Inadvertent Enterotomy: Significant Consequences for the Open Ventral Hernia Patient: 1st World Congress on Abdominal Wall Hernia Surgery; 2015.Google Scholar
  57. 57.
    Colavita PD, Zemlyak A, Burton P, et al. The expansive cost of wound complications after ventral hernia repair. Annual Meeting of the American College of Surgeons Washington, DC; 2013.Google Scholar
  58. 58.
    Elek SD, Conen PE. The virulence of Staphylococcus pyogenes for man; a study of the problems of wound infection. Br J Exp Pathol. 1957;38(6):573–86.PubMedPubMedCentralGoogle Scholar
  59. 59.
    Engelsman AF, et al. The phenomenon of infection with abdominal wall reconstruction. Biomaterials. 2007;28(14):2314–27.CrossRefGoogle Scholar
  60. 60.
    Kaplan JB, et al. Enzymatic detachment of Staphylococcus epidermidis biofilms. Antimicrob Agents Chemother. 2004;48(7):2633–6.CrossRefGoogle Scholar
  61. 61.
    Sadava EE, et al. Does presoaking synthetic mesh in antibiotic solution reduce mesh infections? An experimental study. J Gastrointest Surg. 2013;17(3):562–8.CrossRefGoogle Scholar
  62. 62.
    Birolini C, et al. A retrospective review and observations over a 16-year clinical experience on the surgical treatment of chronic mesh infection. What about replacing a synthetic mesh on the infected surgical field? Hernia. 2015;19(2):239–46.CrossRefGoogle Scholar
  63. 63.
    Hicks CW, et al. History of methicillin-resistant Staphylococcus aureus (MRSA) surgical site infection may not be a contraindication to ventral hernia repair with synthetic mesh: a preliminary report. Hernia. 2014;18(1):65–70.CrossRefGoogle Scholar
  64. 64.
    Brown RH, et al. Comparison of infectious complications with synthetic mesh in ventral hernia repair. Am J Surg. 2013;205(2):182–7.CrossRefGoogle Scholar
  65. 65.
    Jones ME, et al. Emerging resistance among bacterial pathogens in the intensive care unit–a European and North American Surveillance study (2000–2002). Ann Clin Microbiol Antimicrob. 2004;3:14.CrossRefGoogle Scholar
  66. 66.
    Huijsdens XW, et al. Methicillin-resistant Staphylococcus aureus in Dutch soccer team. Emerg Infect Dis. 2006;12(10):1584–6.CrossRefGoogle Scholar
  67. 67.
    Bode LG, et al. Preventing surgical-site infections in nasal carriers of Staphylococcus aureus. N Engl J Med. 2010;362(1):9–17.CrossRefGoogle Scholar
  68. 68.
    Blatnik JA, et al. In vivo analysis of the morphologic characteristics of synthetic mesh to resist MRSA adherence. J Gastrointest Surg. 2012;16(11):2139–44.CrossRefGoogle Scholar
  69. 69.
    Ousley J, 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(2):470–7.CrossRefGoogle Scholar
  70. 70.
    Leber GE, et al. Long-term complications associated with prosthetic repair of incisional hernias. Arch Surg. 1998;133(4):378–82.CrossRefGoogle Scholar
  71. 71.
    Berrevoet F, et al. Infected large pore meshes may be salvaged by topical negative pressure therapy. Hernia. 2013;17(1):67–73.CrossRefGoogle Scholar
  72. 72.
    Robinson TN, et al. Major mesh-related complications following hernia repair: events reported to the Food and Drug Administration. Surg Endosc. 2005;19(12):1556–60.CrossRefGoogle Scholar
  73. 73.
    Shah BC, et al. Not all biologics are equal! Hernia. 2011;15(2):165–71.CrossRefGoogle Scholar
  74. 74.
    Kissane NA, Itani KM. A decade of ventral incisional hernia repairs with biologic acellular dermal matrix: what have we learned? Plast Reconstr Surg. 2012;130(5 Suppl 2):194S–202S.CrossRefGoogle Scholar
  75. 75.
    Le D, et al. Mesh choice in ventral hernia repair: so many choices, so little time. Am J Surg. 2013;205(5):602–7; discussion 607.CrossRefGoogle Scholar
  76. 76.
    Cevasco M, Itani KM. Ventral hernia repair with synthetic, composite, and biologic mesh: characteristics, indications, and infection profile. Surg Infect. 2012;13(4):209–15.CrossRefGoogle Scholar
  77. 77.
    Harrell AG, et al. In vitro infectability of prosthetic mesh by methicillin-resistant Staphylococcus aureus. Hernia. 2006;10(2):120–4.CrossRefGoogle Scholar
  78. 78.
    Machairas A, et al. Prosthetic repair of incisional hernia combined with elective bowel operation. Surgeon. 2008;6(5):274–7.CrossRefGoogle Scholar
  79. 79.
    Carbonell AM, et al. Outcomes of synthetic mesh in contaminated ventral hernia repairs. J Am Coll Surg. 2013;217(6):991–8.CrossRefGoogle Scholar
  80. 80.
    Slater NJ, et al. Large contaminated ventral hernia repair using component separation technique with synthetic mesh. Plast Reconstr Surg. 2015;136(6):796e–805e.CrossRefGoogle Scholar
  81. 81.
    Deerenberg EB, et al. Experimental study on synthetic and biological mesh implantation in a contaminated environment. Br J Surg. 2012;99(12):1734–41.CrossRefGoogle Scholar
  82. 82.
    van’t Riet M, et al. Mesh repair for postoperative wound dehiscence in the presence of infection: is absorbable mesh safer than non-absorbable mesh? Hernia. 2007;11(5):409–13.CrossRefGoogle Scholar
  83. 83.
    Muhlhofer HM, et al. Prosthetic joint infection development of an evidence-based diagnostic algorithm. Eur J Med Res. 2017;22(1):8.CrossRefGoogle Scholar
  84. 84.
    Tolino MJ, et al. Infections associated with prosthetic repairs of abdominal wall hernias: pathology, management and results. Hernia. 2009;13(6):631–7.CrossRefGoogle Scholar
  85. 85.
    Chung L, Tse GH, O’Dwyer PJ. Outcome of patients with chronic mesh infection following abdominal wall hernia repair. Hernia. 2014;18(5):701–4.CrossRefGoogle Scholar
  86. 86.
    Bueno-Lledo J, et al. Partial versus complete removal of the infected mesh after abdominal wall hernia repair. Am J Surg. 2016;214(1):47–52.CrossRefGoogle Scholar
  87. 87.
    Mihai MM, et al. Microbial biofilms: impact on the pathogenesis of periodontitis, cystic fibrosis, chronic wounds and medical device-related infections. Curr Top Med Chem. 2015;15(16):1552–76.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • K. M. Coakley
    • 1
  • B. T. Heniford
    • 1
  • V. A. Augenstein
    • 1
  1. 1.Carolinas Laparoscopic and Advanced Surgery Program, Carolinas Medical CenterCharlotteUSA

Personalised recommendations