Posterior Inguinal Wall Reinforcement after Mesh Removal for the Infected Mesh

Background: Repair of an inguinal hernia either laparoscopic or open repair is one of the most common procedures worldwide. Prosthetic mesh for repair of an inguinal hernia is widely used, it decreases the rate of recurrence, and however, infection of the mesh remains one of the challenging surgical management. Definitive treatment of infected mesh is the removal of the infected mesh; the posterior inguinal wall is reinforced using cremasteric apparatus; which is used as autogenous flap reconstruction for the posterior inguinal wall.

Patients and Methods: Twelve patients were included in the study, between January 2014 to January 2018. Those patients with refractory mesh infection after open repair of an inguinal hernia, with either a sinus discharging pus or exposed mesh.

Results: All twelve patients (100%) recruited in our study get rid of their infection. Eleven patients (91%) had no recurrence after 3 years follow up, while one patient (0.08%) had a recurrence after 2 months; which was supra vesical type of an inguinal hernia. Operative time was 70±10 minutes, bleeding was minimal and no major complication was recorded.

Conclusion: Infected mesh removal and reinforcement of the posterior inguinal wall by cremasteric apparatus as the autogenous flap is a safe and effective one-step surgical treatment for infected mesh post repair of an inguinal hernia.