Behind The Knife: The Surgery Podcast Clinical Challenges in Hernia Surgery: Mesh Infections - How to Treat and What to Consider
Nov 3, 2025
Dr. Amber Sandoval, an abdominal wall reconstruction fellow, and Dr. Peter Farron, chief surgical resident at OHSU, dive into the complexities of mesh infections in hernia repair. They discuss risk factors like BMI and smoking, effective source control methods, and the importance of tailored antibiotic strategies. The duo explores mesh properties that influence infection rates and recovery, and the optimal approach to explant—favoring complete removal over partial. A practical treatment algorithm guides listeners through effective management strategies for these challenging cases.
AI Snips
Chapters
Transcript
Episode notes
Separate Patient And Operative Risk Factors
- Risk factors split into patient (immunosuppression, obesity, smoking, diabetes) and operative (urgency, long op, contamination, dead space).
- Onlay plane has higher risk due to poor vascularity of fat and larger dead spaces.
Prioritize Source Control And Cultures
- Obtain source control first by draining collections and debriding as needed before tailoring further treatments.
- Send deep wound or drain cultures and start empiric broad-spectrum antibiotics, narrowing once results return.
Mesh Material Dictates Salvage Potential
- Mesh construct and porosity determine salvageability because they affect bacterial hiding and vascular ingrowth.
- Monofilament macroporous meshes integrate and clear contamination better than multifilament or ePTFE sheets.