Late-onset deep mesh infection: a study of eight cases detected from 2666 consecutive patients with abdominal wall hernia repairs

Meshes have been applied in abdominal hernia repair for lower recurrence rate and less postoperative pain. According to several guidelines, tension-free repair has been considered the gold standard for hernia repair. However, complications related to mesh implantation still exist, such as late-onset deep mesh infection. This rare complication was first defined by Mann et al. in 1998. Since then, similar cases have been reported.Late-onset mesh infection is defined as acute inflammatory response in surgical area within months or years after operation. It is diagnosed by the presence of infection symptoms and imaging examinations. Classic symptoms include chronic pain, visible operation scars, and red and swollen skin with tenderness. In some situations, pus is visible and fistulas were accessible via physical examination. In ultrasound imaging, a mixed echogenic mass is located between muscle layers even deeper. Computed tomography reveals abnormal density of soft tissue with fuzzy space appearance around the patch site. In cases with fistulas, fistulography can be used. In this report, we analyzed eight cases of late-onset deep mesh infection from 2666 consecutive patients with abdominal wall hernia repairs. This is one of the largest reported series since 1998. A further comprehensive discussion on the diagnosis and treatment of late-onset deep mesh infection is also included.