194 Mesh Infection Following Abdominal Wall Reconstruction: Managing Disaster

Abstract Aim This case series explores the complex landscape of managing mesh infection following abdominal wall reconstruction (AWR). We evaluate different strategies and their outcomes. Method Four patients AWR developed post operative mesh infection following AWR. All patients were discussed in abdominal wall MDT and a personalised strategy established. Patients A, B, and C required further major surgical intervention, while Patient D was successfully managed conservatively. Patients have been followed up to assess long term outcomes. Results Patient A, underwent repair of a midline and parastomal hernia with Phasix ST mesh. Wound dehiscence and subsequent infection required laparotomy, removal of mesh and negative pressure wound therapy (NPWT). They are currently being considered for final AWR. Patient B developed recurrent infection after retro-rectus Prolene mesh repair. Despite repeat wound exploration and drainage of infection, mesh could not be salvaged. Definitive AWR with bridging mesh and component separation facilitated complete recovery. Patient C presented with infected mesh and enterocutaneous fistula 9 years after onlay repair with Bard Composix mesh. He required mesh removal, fistula resection, and subsequent definitive AWR with bilateral retro-rectus repair, transverse abdominis release, and Phasix mesh placement achieving complete healing. Patient D developed infected seroma following incisional hernia repair elsewhere with onlay Parietex mesh. Conservative management with antibiotics and NPWT allowed resolution. Conclusions Mesh infection is a hernia surgeon’s nightmare, however with a considered personalised multidisciplinary approach disaster can be averted. This case series demonstrates how successful outcomes can be achieved in the most unlikely of patients.