What are the management options for recurrent incisional hernia repair mesh infections?

Hello Dr. Chandrashekhar,

Thank you for your query regarding the management of mesh infections following recurrent incisional hernia repair.

General Management Approach

1. Assessment

   • Evaluate the extent and severity of the infection using clinical examination, laboratory markers, and imaging if necessary.
   • Differentiate between superficial and deep-seated infections.
     
     

2. Conservative Management

   • For localized or superficial infections, initiate broad-spectrum antibiotics based on culture sensitivities.
   • Consider percutaneous or surgical drainage if abscess formation is identified.
     
     

3. Mesh Removal

   • In cases of deep or persistent infections, removal of the mesh may be necessary.
   • Timing of explantation should be determined based on the patient’s clinical stability and response to conservative measures.
     
     

4. Adjunctive Therapies

   • Negative Pressure Wound Therapy (NPWT) can be considered to promote wound healing and manage chronic infections.
   • Optimize the patient’s nutritional and immunological status prior to any re-intervention.
     
     

5. Multidisciplinary Collaboration

   • Engage with infectious disease specialists and consider a team approach to tailor the management plan according to the patient’s overall condition and specific infection characteristics.