I had an incisional hernia fix a month back, and now the incision is draining pus. Please help.

Question

Hello doctor,

I have had seven abdominal surgeries, namely gastric bypass, laparoscopic cholecystectomy, exploratory laparoscopy, panniculectomy, ventral hernia repair, mesh removal from hernia repair with exploratory laparoscopy, and recently open epigastric incisional hernia fix a month back. Immediately upon opening my eyes after surgery, I knew something was different, I had extreme pain, more pain than I have ever had with any surgery. Within one week my incision opened, both at the top and bottom. It drained significant amounts of fluid, which went from serosanguinous to seropurulent drainage, on four occasions. At this time, the upper part of my incision is open to a depth of 1.96 inches. I have been packing it for two weeks with no improvement.

I almost completed Augmentin but developed a rash and was switched to Bactrim DS. I continue to have severe pain and see no signs of improvement. I am actively draining yellow to green pus that has a very slight odor which continues to increase. I have only had a low-grade fever, I am fatigued, and feel unwell. I am a registered nurse, and to me, all these are the signs that the mesh is preventing my incision from healing. I had complications from the mesh placed during my first hernia repair as well. I was supposed to return to work, but I would like the incision to be opened, cleaned out, and mesh removed. As I am a nurse, the PA is treating me for MRSA, and they have not cultured the wound. At this time, would it be a good idea to have the mesh removed? Or should something else be done?

Answer 1

Hi,

Welcome to icliniq.com.

It is very unfortunate that you had to go through all that. After reviewing the information shared and your pictures (attachment removed to protect patient identity), it appears you are suffering from surgical site infection. Following are the possibilities:

Infection and liquefaction of panniculus of the abdominal wall.
Mesh is infected.

The risk of infection and liquefaction of panniculus will depend on the thickness of the subcutaneous fat in the abdominal wall. This is common in a morbidly obese patient. The most important question is whether the mesh is infected? There is only one way of finding out, it is to open the wound and take out the mesh. Given your prolonged postoperative course, fevers and constant severe pain, I think the best course would be as follows.

Open the wound.
Irrigate and lavage it daily with or without an infant feeding tube.
Twice a day saline dressing till pus is clear.
If the mesh is already infected, it will be very easily evident.
If the mesh is not infected, opening the wound is not going to infect it after two weeks.
No amounts of antibiotics are going to help here unless the wound is thoroughly lavaged.
Even without opening the whole wound, lavage with a feeding tube will help.

I hope that helps in addressing your concerns.Talk to your doctor regarding the above information. In case you need more information, kindly follow-up with a couple of good quality pictures of the site, by placing a ruler or scale by the side. Do not use a metal ruler (it will shine). If using a plastic ruler, paste a strip of white paper behind a transparent ruler to make its markings prominent.

I had an incisional hernia fix a month back, and now the incision is draining pus. Please help.

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