Sunay N Bhat, MS, Santhosh Koppal, DNB, Gokul K Shanker, MSDNBMBA. VGM Gastro centre, Coimbatore
Introduction: The incidence of atypical mycobacteria associated mesh infections (AMAMI) is underreported. These infections are often treated as surgical site infections which do not respond to regular antibiotics. The present study is aimed at diagnosing AMAMI and its treatment options.
Methods: Twelve cases of AMAMI after laparoscopic inguinal hernia repair presented between 2012 to 2017. All cases were started on antimicrobial therapy initially but the wounds never healed. All cases presented with erythematous, indurated,painful swellings at the working port site. Four cases had persistent discharging sinus, 3 cases had pain around the site of mesh placement and low grade fever. Wound swab was sterile. Ultrasonogram and CECT whole abdomen showed abscess cavity in the abdominal wall extending to the pre-peritoneal space without signs of peritonitis. After failure to respond to broad spectrum antibiotics, atypical mycobacteria infection was strongly suspected. Pus sent for PCR and found positive for mycobacterium fortuitum in 5 of these cases. A clinical diagnosis of AMAMI was made. All the cases were treated conservatively initially with oral Clarithromycin and oral Ciprofloxacin.Four cases needed mesh explantation. A drain was left in-situ for 1-2 weeks. There have been no such infections at our institute after the use of plasma sterilizer.
Results: After two weeks of therapy, the amount of discharge from the wound reduced and indurations subsided. In 8 cases, the symptoms improved considerably after treatment for 6 to 8 weeks. Oral Clarithromycin and Ciprofloxacin were continued for 12 weeks to prevent relapse. Four cases underwent mesh explantation after 6 to 8 weeks of no significant clinical improvement with conservative treatment. Nine cases were asymptomatic after 1 year of completion of treatment. Three cases were lost for follow-up.
Conclusion: Conservative management with second line of anti-tubercular drugs for a period of 12 weeks may be successful in controlling AMAMI in most cases and the morbidity of mesh explantation can be avoided. Many pus samples failed to confirm the presence of atypical mycobacteria but since the presentation in all the cases were similar, the response with oral Clarithromycin and oral Ciprofloxacin has been satisfactory in our series. Whenever a tacker is reused, it should be sterilized by ethylene oxide or plasma sterilization. Where ethylene oxide sterilization facility is not available, tacker reuse may be a point of concern in preventing atypical mycobacterial infection and 1.0 polypropylene suture for fixing the mesh may be used.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93847
Program Number: P571
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster
sages_adbutler_leaderboard