Purulent-inflammatory complications after inguinal hernioplasty with mesh implants

The OBJECTIVE was to perform a systematic review of literature on purulent complications following mesh-based inguinal hernioplasty, analyzing incidence, risk factors, microbiological profile, and modern approaches to prevention and treatment.METHODS AND MATERIALS. Systematic search was conducted in PubMed, Scopus, Web of Science, eLibrary databases for 2020–2025 using keywords: inguinal hernia, mesh infection, hernioplasty, surgical site infection, biofilm. Inclusion criteria: original studies and systematic reviews with sample size ≥50 patients describing infectious complications after hernioplasty with synthetic implants. Exclusion criteria: publications without microbiological data, animal studies, lack of full text. Quality assessment performed using Newcastle–Ottawa scale for cohort studies and Cochrane Risk of Bias tool for randomized controlled trials.RESULTS. 40 studies were included. Infection rates were 0.3–0.5 % for laparoscopic and 1.5–2.1 % for open procedures. Main pathogens: Staphylococcus aureus (35–45 %), coagulase-negative staphylococci (25–30 %), gram-negative bacteria (15–20 %). Biofilm formation occurs within 10 hours of contamination. Major risk factors: obesity (OR 2.1; 95 % CI 1.5–2.9), diabetes mellitus (OR 1.7; 95 % CI 1.3–2.2), smoking (OR 2.5; 95 % CI 1.8–3.4), operative time >180 minutes (OR 2.3; 95 % CI 1.6–3.1), emergency surgery (OR 4.2; 95 % CI 2.8–6.3). Antibiotic prophylaxis with cefazolin reduces infection risk from 4.18 % to 2.38 % (OR 0.61; 95 % CI 0.40–0.92). Conservative treatment with mesh salvage is effective in 40–60 % of cases with macroporous polypropylene meshes and early diagnosis. Mesh removal required in 60–75 % of deep infections, with hernia recurrence risk of 30–45 %.CONCLUSION. Purulent complications after mesh hernioplasty remain a relevant problem. Key prevention strategies include preoperative optimization of high-risk patients, rational antibiotic prophylaxis, and strict asepsis. Treatment requires individualized approach considering implant type, timing of manifestation, and microbiological profile.