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Hernia Mesh Rejection

I had ventral hernia repair 11-17-09 and have had "issues" since then. During the surgery another hernia was found wrapped around the first hernia. My one hour procedure turned into a 4.5 hour procedure and it has now been 7 weeks and I continue to have problems. I was on a one week course of antibiotics immediately after surgery and then approximately 10 days after surgery was started on another antibiotic for 2 weeks due to some redness around the incision area. At my first post op visit (1 week postop) the physician's assistant cut away some larger scabs stating this would promote healing. At the top of my incision (right below my belly button) I had a very small, 1/4 inch, opening. I asked about it and was told that it would heal just give it time.

Went back in another week and opening was still not closing and the areas that the scabs had been cut were not closing. Well, again this area was cut away a little bit. within a few days I called complaining of increased pain and redness and was again placed on two additional antibiotics (both were combinations of 2 antibiotics).

After another week, went back again and was told that I was rejecting the internal stitches and that they were working their way out and the P.A. cut them out and left a rather large open area and told me to begin wet to dry dressing changes 3xday. I work in home care and had the wound nurse look at it and she thought packing it with a silver based gauze would be better and the amount of drainage I have is unbelievable. I continue to have horrible pain all the time that feels like I am being burned from the inside out and if I bend over it feels as though I am being cut in half.

I am so upset and just know that this is not normal. I have an appointment next week and want to know what to ask for to get an actual diagnosis.

FYI -- No cultures have been done of my drainage and no xrays or CT scans of painful area. Also, porcine mesh was used.

Sorry so long and any help would be greatly appreciated.
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replied January 9th, 2010
If the mesh is not involved by your incisional infection, then there is a good chance that the infeciton will resolve over time, and your wound will heal, with appropriate wound care (assuming that you, and the involved skin, are otherwise healthy). However, if the prosthetic mesh is also involved with the infection, then it may or may not be possible to eradicate the infection with antibiotics alone.

In general, I would advise that your wound be cultured (to ensure that the choice of antibiotics is appropriate). If there is a deep, or persistent, or recurring infection in the skin and soft tissues of your incision, then a CT scan should also be at least considered to assess for signs of deep infection involving the mesh (although the mesh can be infected without this necessarily being obivous on the CT scan).

You should make an appointment directly with your surgeon to discuss your concerns.

Sincerely/ Robert A. Wascher, MD, FACS

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replied January 28th, 2010
Response to Mesh Rejection
Get a second opinion from a different surgeon ASAP. Go somewhere else outside of the clinic or hospital that you currently go. I too had hernia repair in Sept. 09. I too have a wound that will not heal. You can see the mesh. I too was given antibiotics and have been seeing a wound care nurse. I went for a second opinion and was told that I need to have the mesh taken out. They can use pig skin in place of mesh and it is much safer and much less of a risk for rejection. I was told that no matter how many antibiotics they throw at you, it doesn't solve the problem. Please go get a second opinion ASAP!!!! You should also have a cat scan of the abdomen done as well, to see what other damage could be happening.
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