The salvage of mesh infection after hernia repair with the use of negative pressure wound therapy (NPWT), a systematic review

Background Mesh infection is the most feared postoperative complication after abdominal wall hernia repair, often needs mesh removal. Negative pressure wound therapy (NPWT) has been used in these situations with diverse results. The aim of this study was to investigate the efficacy of the NPWT in the treatment of mesh infection, the primary outcome was the mesh salvage rates of different type of meshes and mesh positions. Methods Major databases were searched using the keywords negative pressure wound therapy, VSD, vacuum assisted, hernia, mesh infection, including various combinations of the terms. All relevant articles and reference lists in these original studies were also obtained from the above databases. Results Ten articles containing 265 patients on the treatment of mesh infection after hernia repair with the use of NPWT method were included. The general infected mesh salvage rate with NPWT was 76.2%. The highest mesh salvage rate was achieved in polypropylene mesh (93.5%), followed by Proceed mesh (83.3%), and the mesh salvage rate was lower in polyester mesh (PCO) (0%) and the ePTFE mesh (14/3%). The salvage rate was higher when mesh placed in the onlay position (82.6%) or retromuscular/sublay position (98.5%), but lower in the IPOM position (55.6%). Conclusion The treatment of mesh infection after hernia repair should be individualized according to the mesh type, mesh position and the severity of infection. Infected mesh with favourable mesh materials (large pore and monofilament polypropylene) and favourable positions (onlay or sublay/retromuscular) can be salvaged with the use of NPWT based conservative method.