Conservative management of infection in a polypropylene mesh used in hiatoplasty for the treatment of gastroesophageal reflux disease

Eduardo N Trindade, MD, Manoel R Trindade, PhD, MD, Elenisa P Zanella

Department of Surgery, Universidade Federal do Rio Grande do Sul (UFRGS) and Division of Digestive Surgery, Hospital de Clinicas de Porto Alegre (HCPA)

Background: Mesh hernioplasty is the preferred surgical procedure for large abdominal wall hernias. Infection remains one of the most challenging complications of this operation. Salvaging infected prosthetic material after hiatal hernia repair is rarely successful. Most cases require mesh excision and complex abdominal wall reconstruction, with variable success rates. In this article, we report one case of infected mesh salvage after a laparoscopic hiatal hernioplasty with prosthesis without removing the mesh, using antibiotics. A patient with a history of gastroesophageal reflux disease and diaphragmatic hernia starts to complain of frequent heartburn, regurgitation and dysphagia. It was performed then fundoplication laparoscopic surgery and hernia prosthesis hernioplasty. One month after his surgery, he returns to hospital with abdominal pain and fever above 38 degrees. In tomography of the abdomen fluid collection was identified located posteriorly to the fundus which suggests abscess. It was drained and the collection began with antibiotic Ampicillin / Sulbactam rather than the removal of the prosthesis. On the sixth postoperative day new abdominal CT showed significant regression of the collection. After seven days of antibiotics the patient is discharged from hospital in good general condition, afebrile and no complaints of pain. Conclusion: Infected mesh after laparoscopic hiatal hernioplasty with prosthesis may be amenable to conservative treatment. A conservative approach, which includes draining the infection and the use of antibiotics, is a potential alternative for removal of the prosthesis in carefully selected patients

Session: Poster Presentation

Program Number: P614

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