Abstract
Background: The use of synthetic mesh was a landmark breakthrough in management of hernia repair and has significantly reduced recurrence rates. It is a foreign material, and a slightest breach in asepsis can lead to favourable environment for bacterial proliferation and forms a ‘biofilm’ and thus mesh infection. Identifying the risk factors associated with mesh infection will help us prevent the vicious cycle of hernia surgery leading to mesh infection, re surgery to address the infected mesh and so on.
Methods: A retrospective descriptive study was conducted in our centre for a period of two years (November 2017 to November 2019) to study the incidence of mesh infection after hernia repair and the factors associated with it. All primary hernia repairs were done on elective basis and antibiotics was given as per the protocol of our hospital. Patient demographics like age, sex and other factors associated with mesh infection like history of tobacco consumption, BMI, ASA grade, duration of surgery, type of hernia, type of repair, type of mesh used, were taken from medical records and their association with mesh infection was analysed. The results were statistically expressed in the form of mean, standard deviations and percentages.
Results: A total of 10 cases of mesh infection were recorded out of 485 hernia surgeries. In contrary to other studies, in our study mesh infection was more common after laparoscopic surgeries. It was detected that there was a lapse in the sterilisation of laparoscopic instruments which led to the infection, which was rectified by vigilant sterilisation of the laparoscopic instruments and. Two laparoscopic hernioplasty were performed as the second surgery in the day, i.e was followed by laparoscopic cholecystectomy which was suspected be one of the cause for increased incidence in mesh infection after laparoscopic surgery. Laparoscopic instruments were reused in these two procedures which were avoided thereafter. It was more common in obese patients with an average BMI of 31.70+/-1.68 kg/m2. Supporting other studies our study had higher incidence among elderly men, obese patients, uncontrolled Type2 DM, patients with tobacco consumption, higher BMI and higher ASA grade.
Conclusions: Strict sterilisation of laparoscopic instruments is a must for laparoscopic hernia surgery. Laparoscopic hernia repair should be preferably performed as the first surgery of the day. Modifiable causes of prolonged duration of surgery like orientation of the operating and nursing staff to the procedure, availability of the instruments can prevent unnecessary delay in the procedure and thus prevent mesh infection. Optimization of the patient factors like reduction of weight, quitting tobacco consumption and tight control of Type 2 DM are measures to be taken to prevent mesh infection.

Key words: Mesh infection, Hernioplasty, Laparoscopic surgery