Vázquez-Mellado DA

Language: Spanish
References: 22
Page: 230-234
PDF size: 106.01 Kb.

ABSTRACT

Objective: To review the available evidence on infections of prosthetic ventral and inguinal hernia repairs.
Setting: Experimental surgery unit. Universidad del Valle de México.
Design: Review article.
Material and method: The literature available in Medline was reviewed. The assessed variables were: incidence, prevention, and treatment of the infections secondary to prosthetic hernia repair, as well as the bacteriological behavior of conventional polypropylene and of the new materials, such as partially absorbable light prostheses, dual prostheses, and biomaterials. We analyzed the relevant aspects of these materials in regard to infection and their use in contaminated wounds and in clean contaminated wounds.
Results: Infections occur in 3-4% of inguinal hernias and in 8-14% of ventral hernias. Prophylaxis: there is not enough evidence to support its usefulness or that benefits exceed costs and complications associated to their use. Re-sterilization: the use of polypropylene with an adequate technique has not been proven to increase frequency of infections. The profusion of diverse materials is such, that it is not possible to establish a consensus regarding utilization criteria of each of them in terms of infections. There is evidence allowing for the use of polypropylene in contaminated wounds, as long as the surgical zone is cleaned with superoxidized water. When there is an infection related to the mesh (purulent superficial wound, deep infection or necrotizing fasciitis) the prosthetic material must be removed to attain resolution.
Conclusion: Prosthetic material can be used with an ample safety margin, even in contaminated wounds, as long as they are adequately cleaned; if there is a formal infection secondary to the use of prosthesis, this must be removed.

REFERENCES

1. Deysine M. Inguinal herniorrhaphy: 25-year results of technical improvements leading to reduced morbidity in 4,029 patients. Hernia 2006 ;10: 207-12.

2. Sanchez-Manuel FJ, Seco-Gil JL. Antibiotic prophylaxis for hernia repair. The Cochrane Database Syst Revi 2007: Issue 1

3. Aufenacker TJ, Koelemay MJ, Gouma DJ, Simons MP. Systematic review and meta-analysis of the effectiveness of antibiotic prophylaxis in prevention of wound infection after mesh repair of abdominal wall hernia. Br J Surg 2006; 93: 5-10.

4. Vazquez CS, Alcántara MF, Gracida MN, Corona CF, Palomeque LA, Ramírez VJ, et al. Eficacia de la Cefalotina 2 g iv dosis única como antibiótico profiláctico para plastía inguinal con malla. Cir Gen 2005; 27: 269-274.

5. Cingi A, Manukyan MN, Gullough BM, Bartas A, Yegen C, Yalin R, et al. Use of resterilized polypropylene mesh in inguinal hernia repair: a prospective, randomized study. J Am Coll Surg 2005; 201: 834-40.

6. Cisneros MHA. Estudio clínico comparativo con el uso de malla de polipropileno nueva y re-esterilizada para la reparación de hernias inguinales. ¿Hay diferencia? Cir Gen 2005; 27: 275-279.

7. Birolini C, Utiyama EM, Rodrigues AJ Jr, Birolini D. Elective colonic operation and prosthetic repair of incisional hernia: does contamination contraindicate abdominal prosthesis use? J Am Coll Surg 2000; 191: 366-72.

8. Campanelli C, Nicolosi FM, Pettinari D, Avesani EC. Prosthetic repair, intestinal resection, and potentially contaminated areas: safe and feasible? Hernia 2004; 8: 190-192.

9. Harrell AG, Novitsky YW, Kercher KW, Foster M, Burns JM, Kuwada TS, et al. In vitro infectability of prosthetic mesh by methicillin-resistant Staphylococcus aureus. Hernia 2006; 10: 120-124.

10. Ott R, Hartwig T, Tannapfel A, Blatz R, Rodloff AC, Madaj-Sterba P, et al. Biocompatibility of bacterial contaminated prosthetic meshes and porcine dermal collagen used to repair abdominal wall defects. Langenbecks Arch Surg 2007; 392: 473-8.

11. Parker DM, Armstrong PJ, Frizzi JD, North JH Jr. Porcine dermal collagen (Permacol) for abdominal wall reconstruction. Curr Surg 2006; 63: 255-8.

12. Franklin ME Jr, Gonzalez JJ Jr, Glass JL. Use of porcine small intestinal submucosa as a prosthetic device for laparoscopic repair of hernias in contaminated fields: 2 year follow-up. Hernia 2004; 8: 186-189.

13. Cobb WS, Burns JM, Peindl RD, Carbonell AM, Matthews BD, Kercher KW, et al. Textile analysis of heavy weight, mid-weight, and light weight polypropylene mesh in a porcine ventral hernia model. J Surg Res 2006; 136: 1-7.

14. Martinez MA. Superoxidized water (Microcyn 60) for mesh hernioplasty in grossly contaminated fields. An experimental study. American Hernia Society, Hernia Repair 2005; Meeting Book p. 190.

15. Vazquez MA. Necrotizing fasciitis, a rare cause of severe disruption of the abdominal wall. American Hernia Society, Hernia Repair 2007, Meeting Book; p 236.

16. Jezupors A, Mihelsons M. The analysis of infection after polypropylene mesh repair of abdominal wall hernia. World J Surg 2006; 30: 2270-8.

17. Delikoukos S, Tzovaras G, Liakou P, Mantzos F, Hatzitheofilou C. Late-onset deep mesh infection after inguinal hernia repair. Hernia 2007; 11: 15-7.

18. Fawole AS, Chaparala RP, Ambrose NG. Fate of the inguinal hernia following removal of infected prosthetic mesh. Hernia 2006; 10: 58-61.

19. Wong CH, Wang YS. The diagnosis of necrotizing fasciitis. Curr Opin Infect Dis 2005; 18: 101-106.

20. Di Mugno M, Runfola M, Magalini S, Sermoneta D, Gui D. Rippled mesh: a CT sign of abdominal wall ePTFE prosthesis infection. G Chir 2006; 27: 384-387.

21. Suliburk JW, Ware DN, Balogh Z, McKinley BA, Cocanour CS, Kozar RA, et al. Vacuum-assisted wound closure achieves early fascial closure of open abdomens after severe trauma. J Trauma 2003; 55: 1155-1160.

22. Karmali S, Evans D, Laupland KB, Findlay C, Ball CG, Bergeron E, et al. To close or not to close, that is one of the questions? Perceptions of Trauma Association of Canada surgical members on the management of the open abdomen. J Trauma 2006; 60: 287-293.