Wound infection is rare with most hernia surgery, because these are typically clean operations performed electively. The expected wound infection for most repairs is under 1 percent. Similar to other complications, the rate is dependent on risk factors you may have. Well-known risk factors for wound infection include tobacco smoking, diabetes, obesity, known bacterial infection in the area of hernia, and MRSA bacterial exposure. This is why it is so important control these modifiable risk factors prior to committing to an elective hernia repair.
Some patients have risk factors for wound infection that are not modifiable. Examples of such patients include those who have chronic illnesses or are immune-suppressed, such patients on steroids, immune-modulators such as for rheumatoid arthritis, or after organ transplantation.
In cases where the hernia repair is not performed electively, the risk of wound infection increases. This is typically seen in an emergency operation, for an incarcerated hernia (where the contents are stuck and you have pain) or a strangulated hernia (where the contents are stuck and have lost blood flow, sometimes requiring surgery on the intestine).
In situations when wound infection is expected to be high, Dr. Towfigh changes her surgical technique and planned operation to reduce the risk of wound infection as much as possible. Options to reduce wound infection include choosing laparoscopic hernia surgery approach, if possible.
Dr. Towfigh was Clinical Champion for the most successful surgical site infection reduction campaign at Cedars-Sinai Medical Center, a joint project alongside the Joint Commission’s Center for Transforming Healthcare and the American College of Surgeons (www.facs.org). The bundle of care that she follows includes:
- Patient to shower with soap and water the night before and day of surgery. Hibiclens, a chlorhexidine antibacterial soap can also be used.
- Keeping the patient warm
- Appropriate antibiotic choice prior to incision
- Re-dosing of antibiotic if the operation lasts longer than 4 hours
- Frequent change of gowns, gloves, and surgical instruments to clean ones throughout the operation
- Careful handling of tissue to reduce injury during the operation
- Rapid efficient surgery to reduce total operative time
- Minimal use of synthetic product. The risk of hernia recurrence must be weighed by the risk of wound infection
- Variable closure techniques of skin wound*
*Dr. Towfigh performed research on the use of a special wound-probing technique to dramatically reduce wound infection in situations where the wound is contaminated or dirty and at highest risk for wound infection. This is nationally recognized to be a cheap, innovative, and effective modality that doctors, nurses, and even patients can follow.
It is most important to control wound infection, as this is a major risk factor for a deeper infection. If hernia mesh was used for the hernia repair, then this can result in a mesh infection. Mesh infection can be devastating. Depending on the type of mesh used and the place in which it was implanted, there are different rates at salvaging infected mesh. That is, most mesh infections will not be cured with antibiotics alone—the mesh itself needs to be surgically removed. As you can imagine, this can be a very complicated operation. Often times, the patient has to undergo multiple stages of surgery: e.g., one stage, which is removal of the infected mesh, and the second stage being reconstruction of the abdominal wall or hernia.
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Dr. Towfigh has one of the most extensive experiences in treating patients with mesh infection. In fact, it was her experience with this subset of patients that initiated her specialty in hernia surgery in 2002, and how she began her involvement in the American Hernia Society.