Dr Harsh Shah
MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Registered with Gujarat Medical Council, Reg. No. G-38738
Robotic Hernia Surgeon · Apollo Hospital, Bhat, Gandhinagar · Gota OPD, Ahmedabad
In short
Mesh infection is the complication people read about before surgery and worry about after it. It deserves a plain account: what it is, how often it happens, how it shows itself, and what is done about it.
The first thing to say is that it is uncommon, and that most wound problems after a hernia repair are not this.
Bacteria that settle on any implanted material build a thin film over it. Inside that film they are shielded from the body's defences and from antibiotics in the blood. This is why an infection on a mesh behaves so differently from an infection in ordinary tissue.
It also explains the pattern patients describe. Antibiotics are started, things settle, the course finishes, and a few weeks later the same discharge returns. The medicine reached the surface but not the film.
Early infection appears in the first weeks: spreading redness, pain that is getting worse rather than better, fever, and discharge from the wound.
Late infection is the one that surprises people. Months or years after the operation a small opening appears in the old scar and weeps. It dries up, then opens again. That repeating cycle is the clue, and it is worth acting on rather than waiting out.
Telling the common wound problems apart
| What you notice | Most likely cause | What is usually done |
|---|---|---|
| Soft swelling at the site, no fever, settling week by week | Seroma, a collection of fluid | Watched. Most are absorbed over weeks |
| Redness around the stitches in the first week, no discharge | Skin reaction or a surface wound infection | Dressings and a short course of antibiotics |
| Pus from the wound in the first month, with fever | Deeper wound infection, mesh may be involved | Wound opened and drained, scan if it does not settle |
| A small hole in the old scar that weeps on and off for months | Sinus over an infected mesh | Scan and assessment. Often needs the mesh dealt with |
| Pain and a bulge with no redness | The hernia coming back, not infection | Assessed for a further repair |
A wound that keeps opening over an old mesh is worth having looked at properly.
Bring the old discharge summary and any earlier scans to the consultation. They change the plan more than any new test does.
Not every infected mesh comes out. Where the infection is limited to one area and the mesh has grown well into the surrounding tissue, it can sometimes be cleaned, drained and kept. That is a decision made on what is found, not in advance.
Where the mesh has not grown in, or infection runs through it, removal is the reliable answer. Taking a mesh out is a more demanding operation than putting one in, because the material is embedded in scar and the layers must be separated carefully.
Once the mesh is out, the defect is open again. Whether the wall is repaired in the same sitting, or later once the field is clean, depends on how much contamination is present.
It is uncommon. Clean keyhole groin repairs sit at the low end, and large open repairs of the abdominal wall at the higher end. Your own figure depends on the repair you are having.
Yes, though it is unusual. It often shows as a small opening in the old scar that weeps, settles with antibiotics, then returns. A repeating pattern like that is the clue.
Rarely. Bacteria on an implant live in a film that medicine penetrates poorly. Antibiotics can settle the symptoms for a while, but the infection usually returns when they stop.
No. A small area of infection over a mesh that has grown in well can sometimes be cleaned and saved. A mesh that has not grown in, or is infected throughout, usually has to come out.
The defect is open again once the mesh is out, so a further repair is usually needed. It may be done at the same time, or later once the infection has fully cleared.
The main page on this site is robotic hernia surgery in Ahmedabad. These cover the neighbouring questions.
Where to find us
Dr Harsh Shah, MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Shah's Gastro, Cancer & Robotic Surgery Centre
Apollo Hospital, Bhat, Gandhinagar
Gota OPD, Ahmedabad
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