Role of Vacuum-Assisted Closure Therapy in the Management of Exposed Mesh after Ventral Hernia Repair

Abstract

Background: Mesh-related infection after open ventral hernia repair is a clinical dilemma in abdominal wall hernia surgery, especially in the bacterial resistance era. The management of such a problem usually needs complete mesh excision, which results in a high recurrence rate.Objective: The goals of the current study were to evaluate the efficacy of negative pressure wound therapy [NPWT] in infected mesh preservation.Patients and Methods: This prospective study was carried out from January 2017 to December 2019. A total of twenty-four cases with mesh exposure after ventral hernia repair was involved in our study. Patients were categorized into two comparable groups, Group I: VAC was applied for the preservation of the infected mesh, Group II: conventional wound care dressing was used. Patients’ demographics, types of hernia, wound diameter, and the outcomes of each technique were recorded in the study.Results: Out of 24 patients there were 9 males and 15 females, the mean age was 42 years. Types of hernias were 15 paraumbilical hernias, 6 incisional hernias, and 3 recurrent hernias. The wound size in group I ranged from18 x 11 cm – 8.5 x 5 cm and in group II ranged from 16.5 x10 cm – 7 x 5. In Group I, the mesh salvage was accomplished in 11 cases [91.7%] and the wound closed with 2ndary suturing and only 1 [8.3%] patient need partial mesh excision. While In Group II, mesh salvage was accomplished in 5 cases [41.7%] however, 7 [58.3%] patients needed radical en-bloc mesh excision. All the cases had followed up for 6 months.Conclusion: NPWT/VAC therapy has excellent and promising outcomes in the preservation of infected prosthesis.

Keywords

• ventral hernia repair
• infected mesh
• vacuum-assisted closure