Hernia, mesh, microbes, and phage promise: Mapping 35 years of evidence through a systematic review.
Braira Wahid, Edward Young, Morgyn Warner et al.
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In 30 seconds
This systematic review examined published evidence on microbiology and outcomes of hernia mesh infections, including studies from 1990–2025. Of 584 studies meeting inclusion criteria, 32 contributed to meta-analysis. Mesh use was not associated with a consistent reduction in surgical site infections (HR: 0.90; p = 0.396), while mesh explantation was significantly correlated with chronic infection (HR: 6.11; p < 0.0001). Polymicrobial infections were commonly reported with polypropylene mesh, but this may reflect its widespread use. The review found preclinical promise for phage therapy but no clinical studies of phage-coated meshes.
Key findings
- Mesh use did not correlate with a consistent reduction in surgical site infections (HR: 0.90; p = 0.396).
- Mesh explantation was significantly correlated with chronic infections (HR: 6.11; p < 0.0001).
- Polypropylene mesh infections were commonly polymicrobial, often involving S. aureus, E. coli, and P. aeruginosa; reporting bias may contribute.
- No clinical studies of phage-coated meshes were identified; antimicrobial potential was supported by preclinical evidence.
Why it matters
Mesh infection can be associated with substantial morbidity and removal of the implant. This review highlights the relationship between chronic infection and explantation, while showing that infection patterns vary in the published literature and may be influenced by how commonly particular materials are used. Phage approaches remain a research prospect rather than a clinically evaluated option.
What to keep in mind
The evidence is drawn from heterogeneous published studies, and the review notes that polypropylene infection patterns may reflect reporting bias because this mesh is widely used. Clinical efficacy of phage-coated meshes has not been studied.