A Clinical Analysis Of Prosthetic Infection After Tension-free Hernia Repair

Objective:Prosthesis infection is an frequent but important compli-cation in abdominal wall surgery. If the prosthesis infected, long-term hospitallization and intravenous antibiotics will be required. The surgeon will face the dilemma, because taking out the prosthesis can bring a series of problems, and lead to recurrence of hernia. The aim of this study is to evaluate the incidence and risk factors for the infection of the prosthesis after tension-free hernia repair, as well as the diagnosis,prevention and treatment to apply.Methods:Between January 2004 and December 2008,968 cases of hernia patients who underwent tension-free hernia repair were retro-spectively surveyed in the first affiliated hospital of Dalian Medical University:730 inguinal hernias (75.4%),18 umbilical hernias (1.9%), and 220 ventral hernias (22.7%). We analysed preoperative, intrao-perative, and postoperative facts, as well as the incidence of infection of prosthesis. We used ASA classification for preoperative anaesthetic evaluation.Results:The overall percentage of infection of the prosthesis was 1.65%. Infection was observed in 11 repairs with polypropylene mesh (PPL mesh), in 4 with expanded polytetrafluoroethy-lene mesh (e-PTFE mesh), and 1 case in combined mesh. Risk factors of mesh infection were:obesity (P=0.029), diabete (P=0.010), the type of hernia (P<0.001), emergency surgery (P=0.022), the type of prosthesis (P<0.001), time of surgery>180 minutes (P=0.012).We diagnosed the prosthesis infection in strictly accordance with the surgical site infection related portion of the diagnostic criteria of nosocomial infection.On the patients of prosthesis infection, we have examined the bacteriological examination.Of this group of patients: staphylococcus aureus infection is 9 cases, e. coli infection is 4 cases, and mixed infection is 3 cases.Seven of the eleven patients with infection of PPL prosthesis were resolved with conservative treatment, whereas all the cases with e-PTFE prosthesis or mixed mesh infection needed removal to solve the problem.Conclusion:1. Several risk factors are involved in producing a prosthesis infection. In our study:obesity, diabetes, hernia type, emergency operation, patch type, and surgical time> 180 minutes are associated with it.2. For many related factors of causing prosthesis infection, we use the appropriate preventive measures, possibly reduce the incidence of pros-thesis infection, thereby reduce the complicated situation.3.Whereas antibiotic treatment and surgical drainage of the infection can be sufficient in most PPL prostheses infection, e-PTFE prostheses need to be removed prematurely in order to halt the infection process.