Histopathological features and tissue remodeling in chronic abdominal wall mesh infection – a clinicopathological study

BACKGROUND: Chronic mesh infection is a severe implant-associated complication characterized by persistent inflammation and progressive tissue remodeling. This condition is closely associated with foreign body reaction (FBR), fibrosis, and biofilm-related chronic inflammatory processes, which significantly alter the structural integrity of the abdominal wall. PATIENTS, MATERIALS AND METHODS: We performed a retrospective clinicopathological study of patients treated for chronic abdominal wall mesh infection between January 2021 and December 2024. Explanted mesh specimens together with adjacent periprosthetic tissues were collected and processed using standard histological techniques, including formalin fixation, paraffin embedding, and Hematoxylin-Eosin staining. Histopathological (HP) evaluation focused on inflammatory infiltrates, FBR, fibrotic response, and tissue remodeling. RESULTS: HP examination consistently demonstrated foreign body granulomatous reaction characterized by multinucleated giant cells surrounding mesh filaments, associated with chronic inflammatory infiltrates composed predominantly of lymphocytes and plasma cells. Extensive fibrosis and dense collagen deposition with fibrotic encapsulation of the prosthetic material were observed in all cases. These findings were associated with marked structural remodeling of the surrounding soft tissues. CONCLUSIONS: Chronic mesh infection is associated with characteristic HP features, including foreign body granulomatous reaction, chronic inflammation, and extensive fibrosis. These morphological alterations reflect persistent implant-associated inflammatory processes and contribute to progressive tissue remodeling. HP evaluation provides essential insights into the biological mechanisms underlying chronic mesh infection and its long-term tissue effects.