Q: I had undergone laparoscopic mesh hernioplasty for inguinal and paraumblical hernias. Subsequently, I developed intestinal obstruction and underwent laparotomy for intestinal resection. Thereafter, the incisional wounds did not heal and I was diagnosed with AFB +ve infection. I am now under anti-tuberculosis treatment. However, the discharge from the sinuses in the incisional location (paraumblical region) is still continuing. The consultant is of the opinion that the infection is rooted in the mesh at paraumblical region and requires another laparotomy for its removal. Besides, there is a manifestation of two more incisional hernias around the wound and he has advised hernioplasty at a future date for them. Kindly advise whether should I wait for some more time to see the effect of ATT before undergoing surgery. If yes then how long should we wait?

A:My suggestions are as follows: 1. Do not go immediately for mesh removal. Try to give antibiotic therapy a longer chance. 2. You cannot get a repair done for any new hernias till this infection clears up COMPLETELY. 3. This infection may not respond to conventional anti tubercular therapy. The AFB may be non tubercular mycobacteria (NTM), and there are many species that do not respond to conventional antitubercular drugs. The effective drugs are CLARITHROMYCIN and CIPROFLOXACIN. If you are not responding to antitubercular drugs, these two medicines are worth trying. NTM are associated with laparoscopic surgery, and the infection is presently widespread in India, particularly north India.