Behind the Knife.

We are the OHSU hernia team.

I'm Maggie Bosley, one of the hernia wall reconstruction faculty here,

joined by my senior partner, Dr. Sean Orangestein,

our abdominal wall recon fellow, Dr. Amber Sandoval,

and our chief resident on service, Dr. Peter Farron.

Today we're going to be talking about mesh infections and why they matter and how to treat them.

The dreaded complication all hernia surgeons think about.

As we all know, about a half a million ventral hernia repairs are performed a year and even more primary

laparotomies that result in about a 20% hernia rate. And so we know that repairing these hernias

with mesh will decrease our chance of recurrence. But when it comes to placing these foreign bodies

in our patients, we have to understand what are the consequences of that?

What are the potential complications? And then when those arise, what do we do about that?

Historically, people have thought about using antibiotics, potentially talk about mesh,

but there's a lot more nuance than just ex-planning mesh. And so

let's dive into some considerations. First, let's start with talking about some risk factors for

mesh infection. Yeah, so I think when talking about risk factors, we can kind of break it down

into two major categories, patient risk factors and operative risk factors.

So under the patient risk factors category are things like immunosuppression, non-optimized patients.

So obese patients, especially with the BMI over 35, patients who are actively smoking, patients with uncontrolled diabetes, and patients with a history

of post-op surgical site infection.

And then the operative risk factors include things such as urgent repair, prolonged operative

...