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Need advise - infected hernia mesh with hernia recurrence

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  • Need advise - infected hernia mesh with hernia recurrence

    Hello - thank you to all who run this site! Here is a brief summary:
    1/9/2019 - I had a hysterectomy with ventral hernia repair. I had many hernias - the surgeon described it as swiss cheese. Repair was done with biological pig bladder mesh. I had 2 drains
    1/14/2019 - Hospitalized, fever, IV antibiotics, hernia recurrence
    2/2019 - Hospitalized, fever, IV antibiotics, 3rd drain added
    3/2019 - Drains removed, Hospitalized, infected seroma, some of the mesh formed a ball, this was removed and a wound vac placed
    7/2019 - Hospitalized, fever, IV antibiotics, told I had an abscess over the mesh
    8/2019 - consult with infectious disease - says all mesh needs to be removed. My original surgeon offers to fix new hernia with mesh and "explore wound". I decide to receive 2nd opinion.
    9/2019 - 2nd opinion with hernia surgeon - mesh needs to be removed, offers surgery to remove mesh and stitch up hernias, knowing they will recur and then hernia surgery at later date. Says important not to use mesh as it will reinfect.
    10/2019 - 3rd opinion with hernia surgeon, says the same as 2nd opinion. I schedule surgery for December with 2nd opinion surgeon
    11/2019 - 2nd opinion surgeon agrees to a CT scan to see if infection is better - CT shows abdominal dehiscence and a widening gap of my muscles from 6cm in July to 8cm now. He calls to say he may need to use mesh to close because the gap is getting wider. I am alarmed at the thought of more mesh.

    Today - I need advice. Should I get more opinions? I am afraid if I wait any longer the abdominal dehiscence will get worse. The surgery with my 2nd surgeon is schedule for December.

    With gratitude
    Jonsaunt


  • #2
    Hi Jonsaunt,
    I'm very sorry to hear of your medical problems, and I can understand the position you are in.
    I am not a medical person, but I had a hernia tissue repair 12 months ago. Prior to this, I did some research to help me decide the best course of action for myself. I have a biological research background.
    Reading your post, I was wondering whether you have an immune response to the pig bladder mesh. If there was, I imagine it would be only part of the obstacles you face.
    I mention this because I get an immune response to a certain suture product (made from reconstituted animal tissue), also something I came across in my research. The issue may not be universally recognised, perhaps in part because of alternative explanations for patient reactions from manufacturers defending a particular product, and because strong patient immune reactions are not common. I am not trying to generalise here, good medicos would be well aware of the issue.
    All the best with your treatment.
    L....

    Comment


    • #3
      drtowfigh has extensive experience in this area. I would not consider all "meshes" as mesh. "Pig" mesh is not actually a mesh, as I understand things. Good luck.

      Comment


      • #4
        Sorry to hear your problems.
        1. not clear why you had biologic mesh (porcine bladder) used for your hernia repair. Biologic mesh absorbs and do the hernia can recur. It is not considered standard for hernia repairs.
        2. Sounds like the biologic mesh failed. It balled up. You had a lot of seromas which is common with biologic mesh. Thatís why drains are used.
        3. with a mesh infection, all of the implant must be removed in itís entirety, especially when balled up.

        I agree with 2nd opinion. And you definitely need mesh. But not pure biologic mesh. I would use a hybrid mesh such as Ovitex Permanent or a lightweight synthetic mesh if it can be placed under muscle to reduce risk of mesh infection

        - what was the Swiss cheese hernia from in the first place? Ie, what prior surgery caused it?

        - what bacteria grew from the infection?
        #ItsNotJustAHernia
        www.BeverlyHillsHerniaCenter.com

        Comment


        • #5
          Thank you - I am extremely appreciative of the responses.

          drtowfigh Thank you! My 2nd opinion hernia surgeon said the biologic mesh was the wrong choice in mesh. The "swiss cheese hernia" was from a surgery to fix a small bowel obstruction caused by a rare internal hernia in 2006. The bacteria that grew from the drain cultures were Streptococcus agalactiae grp B, CORYNEBACTERIUM STRIATUM, STAPHYLOCOCCUS EPIDERMIDIS
          and a culture of the wound grew MRSA. Do I definitely need mesh because of the size of the gap?

          linzee.1018 1018 - Thank you! yes I have autoimmune issues and many allergies. My personal opinion is that I did have an autoimmune type reaction to the mesh, which hasn't helped the situation. How was your immune response treated?

          Comment


          • #6
            The MRSA history complicated things. If it were me, I would be hesitant to place a pure synthetic mesh and would opt for Ovitex permanent hybrid mesh.
            #ItsNotJustAHernia
            www.BeverlyHillsHerniaCenter.com

            Comment


            • #7
              Hi Jonsaunt,
              My immune response was trivial in that the stitches involved were for skin procedures. Sore to touch, until the stitches dissolved away. Since avoided that brand of sutures.
              I've heard that bacteriophages are starting to be looked at in USA, for dealing with some difficult to treat infections. Have you come across these; bacterial viruses? Probably very impractical at this stage, but just mentioning. Otherwise could enhance options/strategy/buy time where there are no easy options. Have been used in places in Eastern Europe since 1950's.
              All the best......

              Comment


              • #8
                Originally posted by linzee.1018 View Post
                Hi Jonsaunt,
                I'm very sorry to hear of your medical problems, and I can understand the position you are in.
                I am not a medical person, but I had a hernia tissue repair 12 months ago. Prior to this, I did some research to help me decide the best course of action for myself. I have a biological research background.
                Reading your post, I was wondering whether you have an immune response to the pig bladder mesh. If there was, I imagine it would be only part of the obstacles you face.
                I mention this because I get an immune response to a certain suture product (made from reconstituted animal tissue), also something I came across in my research. The issue may not be universally recognised, perhaps in part because of alternative explanations for patient reactions from manufacturers defending a particular product, and because strong patient immune reactions are not common. I am not trying to generalise here, good medicos would be well aware of the issue.
                All the best with your treatment.
                L....
                I too am sorry to read about problems, anyway congratulations for your studies, I have tried but I have not found any evidence of transmission of a biological prosthesis disease. I have also read that it does not need removal even in the case of infection , because it has a low inflammatory power. only on recidivism there is an unfavorable casuistry, though referred to difficult fields. Recently I read the site who are a little favorable, https://trialsjournal.biomedcentral....063-018-3122-5
                ...better no mesh but, in case of mesh, better biologic or sintetic is really controverse
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