Transabdominal mesh, usually constructed of polypropylene (PPL), has become a public health issue in the surgical treatment of stress urinary incontinence (SUI) and pelvic organ prolapse (POP).
While many women undergo the implantation with no issues, some experience mesh complications after the surgery or even years later. One symptom of the more severe complications is usually mesh infections. Symptoms of a mesh infection include high fever, inflammation, pain, and discomfort.
If you had a transabdominal surgery procedure and you are experiencing symptoms or discomfort, please visit your healthcare provider for medical treatment options.
Continue reading to get a comprehensive understanding of transabdominal mesh infections.
Understanding Transabdominal Mesh Infections
Mesh infections are deep infections that arise near the mesh implant. They are distinct from wound infections at the surgical site.
Mesh implant infections may arise months or years after the initial surgery. This problem may emerge due to a poorly designed mesh, mesh material, inadequate surgical technique, or underlying patient concerns.
Bacteria are the most common cause of transabdominal mesh infection. Other causes of mesh infection are as follows:
Design of Meshes
Infections may develop with any mesh, but some mesh designs are more prone to infection. Meshes constructed of materials like extended polytetrafluoroethylene (ePTFE) and polyester, for example, are more susceptible to getting contaminated.
Meshes with tiny hole sizes are more susceptible to infection. Bacteria lurk in the microscopic pores, where immune cells cannot reach them to combat them.
Existing Medical Conditions
If a person has previous health issues, their chance of mesh infection increases. Diabetes, aberrant wound or skin disorders, immunosuppression, COPD, and obesity are examples.
People who smoke are also at a higher risk of infection.
Vaginal mesh is often used in urogynecological operations to treat SUI and POP. It is utilized in the female pelvic floor in three ways: transvaginal therapy for SUI, transabdominal repair of POP, and transvaginal repair of POP.
Mesh infection rates are also lower in abdominal POP repairs than vaginal POP repairs since the first method prevents mesh contamination during insertion.
Recognizing Symptoms and Diagnosis
Here are some symptoms that may indicate you are experiencing mesh infection.
Fever – When a mesh device causes an infection, the patient’s body temperature may increase to try and destroy the harmful bacteria.
Inflammation – The location of the implantation procedure will always be a little painful after surgery. However, if the soreness gets extensive or severe, it might indicate signs of mesh infection.
Polypropylene is used or has been used in many mesh items. This synthetic mesh has been linked to inflammation, which may lead to significant consequences.
Redness – In the days after prolapse repair surgery, some redness is common. However, if the surgical site stays red or becomes red later, this might suggest an infected mesh.
The red or pinkish skin may be sensitive to the touch, depending on the severity of the infection. Seromas (fluid) may also accompany the red skin.
Burning feeling – Like redness, a burning feeling at the mesh incision site, might indicate an infection.
This burning might be minor or severe, intermittent or persistent. However, any persistent burning should be evaluated by a doctor.
Pain – Mild to severe abdominal discomfort is a typical indicator of infection (as well as bowel obstruction, organ perforation, mesh migration, and other mesh problems). Infections, if left untreated, may result in scar tissue and nerve damage.
Other symptoms include headache, flu-like symptoms, discharge, abscess, and organ damage.
Radiological imaging may assist your doctor in determining whether or not the mesh is contaminated and infected. Ultrasounds and CT scans are two examples they use to determine this.
Treating Transabdominal Mesh Infections
After an infection has been confirmed, the patient may need medicinal or surgical intervention. Surgery to remove the mesh may be combined with antibiotics or other intravenous antimicrobial medicines.
When paired with intravenous antibiotics, revision surgery to remove, all or part of the mesh is the most effective therapy for transabdominal mesh infection treatment.
Because bacteria often build a biofilm and a thick capsule around the mesh to defend themselves from antibiotics, antibiotics alone have a low success rate. Infections are difficult to cure without resorting to surgery.
Researchers found evidence that methicillin-resistant staph aureus (MRSA) was present in the mesh infections of 63% of patients. MRSA is far more difficult to treat than staphylococcal bacteria.
Some individuals may need additional procedures due to the complexity and difficulty of the surgical repair.
Infected patients may need to wait for a period of stabilization before undergoing surgery. In these situations, surgical drainage of the infection is performed before mesh removal.
Because removing all the mesh may raise the likelihood of the prolapse returning worse, some clinicians aim to leave as much of it in as possible. In these situations, medical professionals will drain the pus, cleanse the area with saline/povidone-iodine, and remove as much infected tissue as possible.
Biologic mesh manufactured from animal or human tissue and healing utilizing the patient’s own tissue are alternatives to surgery using synthetic mesh-like polypropylene.
The most dreaded consequence of transabdominal prolapse repair is mesh infection, often leading to extended hospital stays and mesh removal. Management of a frequent surgical issue needs familiarity with current prevention, care, and therapy approaches.
Smoking, obesity, diabetes mellitus, and chronic obstructive pulmonary disease are all patient-related risk factors for mesh infections. It is also important to consider surgical risk factors such as type of surgery, pre-existing health conditions, and mesh design.
Obesity and diabetes are only two of the many chronic diseases that may be prevented by addressing modifiable risk factors. Biologic or biosynthetic mesh is advised for contaminated areas. There has been little success in mesh salvage with conservative therapy, including antibiotics, percutaneous or surgical drainage, and mesh removal.
Mesh explantation and subsequent abdominal wall repair are common treatments for mesh infections. While partial repairs are possible, full treatment of prolapse repair with biologic mesh has shown excellent outcomes.
Infections caused by mesh are difficult to treat and are surprisingly prevalent. High-quality information from prospective trials and clinical practice research should continue to back up strategies employed in the prevention and surgical treatment of transabdominal mesh infections.
Contact Plouff Law if you’ve experienced any of the above complications.