How often does hernia mesh get infected? Understanding the risks and prevention

September 30, 2025 •

4 min read

Studies show that the incidence of mesh-related infection after hernia repair is generally low, ranging between 1% and 8% in many series, but varies significantly depending on several factors. This article explores the specific statistics on how often does hernia mesh get infected, highlighting the key risks and effective prevention strategies.

Quick Summary

The incidence of hernia mesh infection is influenced by patient health, surgical method, and mesh type. Symptoms include fever and chronic pain, with treatment often involving antibiotics or mesh removal, depending on severity.

Key Points

Incidence Varies: Mesh infection rates typically range from 1% to 8%, influenced by various factors, with some low-risk elective procedures seeing rates under 1%.
Key Risk Factors: Patient health issues (obesity, diabetes, smoking), open surgery, emergency procedures, and mesh type/porosity are major contributors to infection risk.
Laparoscopic Advantage: Laparoscopic hernia repair generally has a lower risk of mesh infection compared to open procedures.
Biofilm Complication: Chronic mesh infections are difficult to treat with antibiotics alone because bacteria can form a protective biofilm on the mesh.
Treatment Options: Management ranges from antibiotics and drainage for early infections to surgical mesh removal for chronic or severe cases.
Late-Onset Infections: While rare, mesh infections can occur months or even years after the initial surgery.
Patient Health Optimization: Modifiable risk factors like obesity, diabetes, and smoking can and should be addressed before elective surgery to minimize infection risk.

Understanding the Frequency of Hernia Mesh Infection

While hernia repair with mesh is a common and generally safe procedure, the risk of infection is a potential complication. The overall incidence is quite low for most standard elective repairs, with some sources citing wound infection rates under 1%. However, comprehensive reviews have reported broader ranges. A systematic review and meta-analysis of risk factors for abdominal wall hernia repair found a pooled prevalence of mesh infection of 4%. Other studies have reported rates ranging from 1% to 8%, influenced by various factors including underlying patient health and the surgical approach used. For abdominal wall hernias specifically, the risk may increase to as high as 10% in some cases. This demonstrates that while relatively uncommon, the frequency of infection is not insignificant and is highly dependent on a number of key variables.

Factors Influencing Mesh Infection Rates

The likelihood of a mesh infection is determined by a complex interplay of patient-specific conditions, surgical techniques, and mesh characteristics. Understanding these risk factors is crucial for both prevention and proper management.

Patient-Related Risk Factors

Obesity: Patients with a higher body mass index (BMI) face an increased risk due to impaired tissue oxygenation, extensive tissue dissection, and potential wound contamination.
Diabetes: Poorly controlled blood glucose levels can inhibit the immune system's ability to fight off bacteria, making diabetic patients more susceptible to infections.
Smoking: Tobacco use is a well-established risk factor, as it impairs wound healing and immune function, creating a more favorable environment for infection.
Immunosuppression: Chronic illnesses, use of steroids, or other immune-suppressing medications weaken the body's natural defenses.
Advanced Age: Older patients and those with higher ASA scores (a measure of overall health) are also at increased risk.

Surgical-Related Risk Factors

Emergency vs. Elective Surgery: Emergency hernia repairs, especially those involving strangulated bowel, carry a much higher risk of infection due to the potential presence of bacterial contamination.
Laparoscopic vs. Open Repair: Studies show that laparoscopic procedures generally have a lower infection rate (around 0-3.6%) compared to open procedures (6-10%).
Duration of Surgery: Longer operative times can increase the risk of contamination and infection.
Mesh Position: The placement of the mesh can influence risk. For instance, placing the mesh in the retro rectus position has been shown to significantly reduce infection risk in abdominal wall repairs.

Mesh-Related Risk Factors

Mesh Type and Porosity: Some meshes are more prone to infection than others. Microporous mesh, for example, can trap bacteria, making them inaccessible to immune cells and systemic antibiotics. In contrast, macroporous mesh allows for better tissue ingrowth and immune cell access.
Material: Multifilament polyester mesh has been associated with higher infection rates compared to monofilament polypropylene mesh.

Comparison of Infection Risk Factors


Factor Category	High-Risk Characteristics	Low-Risk Characteristics
Patient Health	Obesity, uncontrolled diabetes, smoking, immunosuppression	Healthy BMI, controlled blood sugar, non-smoker, healthy immune system
Surgical Setting	Emergency procedure, long operation time	Elective procedure, short operation time
Surgical Technique	Open repair, onlay mesh placement	Laparoscopic repair, retro rectus (sublay) mesh placement
Mesh Type	Microporous mesh, multifilament polyester mesh	Macroporous mesh, monofilament polypropylene mesh

Recognizing the Symptoms of Mesh Infection

Identifying a mesh infection early is critical for effective treatment. An infection can develop shortly after surgery or, in rare cases, years later.

Key signs and symptoms to look for include:

Chronic Pain: Persistent and worsening pain around the surgical site that lasts long after the normal recovery period.
Fever and Flu-like Symptoms: Systemic signs of infection, such as fever, chills, fatigue, and malaise.
Inflammation and Swelling: Unusual or significant swelling and sensitivity at or around the surgical area.
Redness and Incision Warmth: The skin over the mesh can appear red (erythema) and feel unusually warm to the touch.
Poor Wound Healing: The surgical incision may not heal properly or may develop a chronic discharge or sinus tract.
Gastrointestinal Issues: Symptoms like nausea, vomiting, or bowel obstruction can occur, especially if the mesh is near the bowel.

Treatment Options for Infected Mesh

Management of a mesh infection can be complex and depends on the infection's severity and chronicity. For less severe or early infections, a conservative approach might be attempted, while chronic infections usually require more drastic intervention.

Antibiotics: For minor or early-stage infections, oral or intravenous antibiotics are typically the first line of treatment. However, antibiotics alone are often insufficient for established chronic infections because bacteria can form a protective biofilm on the mesh, shielding them from medication.
Drainage: For localized collections of pus (abscesses), percutaneous drainage may be performed.
Surgical Mesh Removal: In cases where conservative treatment fails or for chronic, deep infections, the gold standard is surgical removal of the infected mesh. This is a more complex procedure than the original repair and can be associated with higher rates of hernia recurrence. Newer techniques are sometimes used to salvage a mesh, but complete removal is often necessary to resolve the infection permanently.

Conclusion

While the prospect of a mesh infection is a serious concern for anyone undergoing hernia repair, it's important to recognize that the overall risk is low, particularly for clean, elective procedures performed laparoscopically. The rate is not static but is influenced by a range of modifiable and non-modifiable factors, including patient comorbidities, surgical technique, and the type of mesh used. Proactive measures such as quitting smoking, managing diabetes, and maintaining a healthy weight before surgery can significantly reduce the risk. For a hernia mesh infection that does occur, early detection of symptoms like chronic pain, fever, and inflammation is critical. While antibiotics may work for early cases, surgical removal of the mesh is often necessary for long-term resolution, especially for chronic infections with biofilm formation. By being informed and working closely with your healthcare provider, you can make empowered decisions and improve your post-operative outcomes.

Frontiers in Surgery study on treatment options

Frequently Asked Questions

A mesh infection can occur anywhere from days or weeks after surgery to months or even years later. Infections appearing long after the procedure are known as late-onset infections, though they are less common.

Major risk factors include pre-existing health conditions such as obesity, diabetes, and smoking. Surgical factors like performing an open vs. laparoscopic procedure, the surgery's duration, and the type of mesh used also play a significant role.

Not always. For superficial or early infections, conservative treatment with antibiotics and drainage may be attempted. However, for chronic or deep infections, or when conservative methods fail, complete mesh removal is often necessary for a cure.

Antibiotics may be effective for treating early or minor infections. However, for established chronic infections, antibiotics often have a poor success rate because bacteria can form a protective biofilm on the mesh, shielding them from medication.

Yes, mesh type and porosity can influence infection risk. For example, some studies suggest that microporous meshes are more prone to biofilm formation compared to macroporous meshes, making them more susceptible to infection.

Common signs include persistent or worsening pain, inflammation, swelling, unusual warmth at the surgical site, fever, chills, and fatigue. Poor wound healing or the development of a sinus tract can also indicate an infection.

You can reduce your risk by addressing modifiable health issues like obesity, diabetes, and smoking before an elective procedure. Adhering to all pre-operative instructions from your surgeon and ensuring proper hygiene are also crucial preventative measures.