dear dr

i suggest drainage of abscess either radiologically or by formal surgery and take culture and sensitivity and start wide spectrum AB . if no response occur after that we should remove the mesh from the field .

greeting

Of course to do a local permanent drainage guides by CT scan together with local and general administration of antibiotics sensible to the type ob organisms cultured in the pus

drainage of the abscess and simultaneous insertion of an appropriately-sized drain with broad spectrum antibiotics.

Thank you,Abscess was drained,staf aureus MRSA positive,corrugated drains were placed after irrigating the wound with Betadine + H2O2, pre op Diag lap showed that mesh looked normal .Ref to ID advice for antibiotics.pt has been warned .

You'd remove the mesh. Until you remove the mesh, purulent process will be supported. You strangle infection, and it 100% breaks out again later.

Hello, Prasanna, I once did a LapChol with open Ing. Hernia darning repair with prolene thread. Unfortunately the lady was dead scared of surgery and not surprising, she developped wound infection seeping out pus. She was so scared that even dressing the wound would alarm her to death. However, I managed to convince the relatives (a wealthy Marawadi local family) and tried to just do simple onlay dressings with frequent gentle curretting of the sinus. No drain but keep open the mouth of sinus. Simple curretting of the sinus track every four-five days did the trick and I was saved of my reputation. Simple curretting of the sinus track once or twice weekly is a good technique hardly exploited, while v keep trying Bookish age old fancy methods for no gain.

NB: Respectfully, I thought the corrugated drains are a means of historical archives. Never used it, instead do my technique with no regrets. Regards, Om

I once did a LapChol with open Ing. Hernia darning repair with prolene thread. Unfortunately the lady was dead scared of surgery and not surprising, she developped wound infection seeping out pus. She was so scared that even dressing the wound would alarm her to death. However, I managed to convince the relatives (a wealthy Marawadi local family) and tried to just do simple onlay dressings with frequent gentle curretting of the sinus. No drain but keep open the mouth of sinus. Simple curretting of the sinus track every four-five days did the trick and I was saved of my reputation. Simple curretting of the sinus track once or twice weekly is a good technique hardly exploited, while v keep trying Bookish age old fancy methods for no gain. Using antibiotics and frequent cultures are useless and needless. Any wound will grow some organism or other but of no pathological relation. We keep blasting patients with antibiotics for ne avail. In such cases, the problem lie in the granulation tissue track. It must be curretted out for the sinus btrack to close and heal, irrespective of infection seen on culture. We need to work on this strategy more.

NB: Respectfully, I thought the corrugated drains are a means of historical archives. Never used it, instead do my technique with no regrets. Regards, Om

I agree with you Dr konstantin,that is the reason why I warned the pt about explantation of mesh as they are worried about the recurrence.

Greetings. REMOVE THE MESH AND DRAIN. The mesh has to be removed otherwise the purulent process will continue irrespective of antibiotics and even drainage.

Continuous cleaning and drainage with saline serum during 48 hours at least!

It is important to remove the mesh and to do a continuous lavage and drainage during the time needed d to solve the problem

We must start thinking beyond our set techniques practiced thus far. The technique I have stated above is not a fiction but my practical experience in few cases. It works and there is no harm in trying but the physio-pathology of the problem must be clearly understood to prevent recurrence or failure of the technique. Yes, removal of mesh remains the last resort but removing the mesh isn't an easy job. I am sure, those who have done it, would know it.

3 months later pt has returned with same problem.Further details revealed Initial repair was done with mesh when it got infected as much of the mesh was possible was removed.PT has been on Tab Lenosolid as per the culture report.Lap explantation of mesh was done and the abscess was drained and remanants of outside mesh was removed as much as possible.

To remove the mesh and a good drainage with continuous lavage and draining. Thats all.

How easy is to remove the implanted mesh? Any experiences, please? My own experience is that it may prove a hell because of its total incorporation in the tissues. If it does not incorporate, then use of its must be questioned.

Om prakash sudrania. Usually after long time the mesh become severely adherents to underlying structure and need efforts to removed .

Simple drain and antibiotics and it will keep on discharging but eventually it will heal. There is a risk of mesh migration and recurrence if the mesh is not well fixed in place

Hasnain Jasim,

My own experience is that removal of mesh is just yet another "mess" and rather unproductive. Hence a better choice is to currette the sinus track, and remove the linning granulation tissue in the sinus track and using antibiotic is unnecessary unless one finds overt signs of inflammation around the sinus opening or any other signs of inflammation. Most of times, this is a chronic long time problem as opposed to an acute episode. Even if it is acute, combatting the acute phase is better then aggressive exploration. Let chronic phase supervene and then treat it conservatively. Of course, it needs infusing enough confidence in the patient by the surgeon and his/her team.

The management is nearly the same, but the question is how to minimize it?