Complex Abdominal Wall Repair in Chronic Mesh Infection With Gastrointestinal Reconstruction

Abstract Aim To present the use of a biosynthetic mesh in a case of complex abdominal wall repair in chronic mesh infection and gastrointestinal tract reconstruction. Material and Methods This is an 89-year-old male with a history of radical cystectomy with Bricker reconstruction. As an immediate complication, he presented intestinal perforation with the need for the creation of an end ileostomy and fascial dehiscence with bridging of the abdominal wall with a bilayered mesh. Post-operatively he developed wound dehiscence with chronic mesh exposure and infection. We performed a complete excision of the infected mesh, reconstruction of the intestinal transit and abdominal wall repair with a Rives technique with left Posterior Component Separation (PCS) according to the Madrid modification, with a prophylactic key-hole for the Bricker ileal Conduit. A biosynthetic scaffold was placed due to the infection situation (CDC-class 4 according to the CDC-Centers for Disease Control classification for Wound infection). Results Postoperatively the patient suffered a surgical site infection with suspected anastomotic leakage that was managed conservatively. Consequently, he developed a wound and an anterior layer dehiscence, with mesh exposition and infection. The complication was managed with antibiotherapy and negative pressure therapy, achieving complete wound closure and resolution of the infection without recurrence of the hernia in the follow-up. Conclusions The use of a biosynthetic scaffold is a feasible and useful resource for abdominal wall reconstruction in patients with chronic mesh infection, with good performance even in the case of early infection and environmental exposition.