Complete versus partial mesh removal for mesh infection after tension-free inguinal hernioplasty: A retrospective study.

Abstract

Mesh infection following tension-free inguinal hernia repair is rare but clinically challenging. When conservative treatment fails, surgical intervention is often required. This study aimed to compare the clinical outcomes of complete mesh removal versus partial mesh removal in patients with mesh infection. We retrospectively reviewed 72 patients undergoing surgery for mesh infection after inguinal hernia repair at our center between January 2016 and October 2025. Patients were grouped according to intraoperative management: complete mesh removal (n = 59) or partial mesh removal (n = 13). Baseline characteristics, perioperative data, postoperative complications, long-term outcomes, and microbiological findings were collected and compared between groups. Baseline characteristics were similar. No clear differences were observed in operative procedures, repair methods, blood loss, operative time, hospital stay, costs, or follow-up. Organ injury was more frequent in the complete mesh removal group but without a clear difference between groups. Postoperative complications and long-term outcomes, including recurrence and ischemic orchitis, were similar. Subgroup findings did not indicate a clear effect of repair technique or laparoscopy on reoperation rates. Microbial culture was positive in 51.2% of cases (22/43), with methicillin-resistant Staphylococcus aureus accounting for 66.7% (12/22). Antibiotic susceptibility was highest for tetracyclines (72.7%), aminoglycosides (68.2%), and sulfonamides (63.6%), whereas β-lactams showed high resistance (penicillins, 4.5%; first-generation cephalosporins, 0%). Partial mesh removal may be considered in carefully selected cases to balance infection control and functional preservation. Complete mesh removal was associated with more organ injury, without a clear difference between groups. Empirical anti-infective therapy should consider coverage for methicillin-resistant Staphylococcus aureus. Given the small sample size of the partial mesh removal group, these findings require validation in larger cohorts.