Intraperitoneal Mesh Implantation for Fascial Dehiscence and Open Abdomen

Overview

Journal World J Surg

Publisher Wiley

Specialty General Surgery

Date 2012 Mar 10

PMID 22402974

Citations 17

Authors

Moritz Scholtes

Anita Kurmann

Christian A Seiler

Daniel Candinas

Guido Beldi

Affiliations

Soon will be listed here.

Abstract

Background: Postoperative fascial dehiscence and open abdomen are severe postoperative complications and are associated with surgical site infections, fistula, and hernia formation at long-term follow-up. This study was designed to investigate whether intraperitoneal implantation of a composite prosthetic mesh is feasible and safe.

Methods: A total of 114 patients with postoperative fascial dehiscence and open abdomen who had undergone surgery between 2001 and 2009 were analyzed retrospectively. Contaminated (wound class 3) or dirty wounds (wound class 4) were present in all patients. A polypropylene-based composite mesh was implanted intraperitoneally in 51 patients, and in 63 patients the abdominal wall was closed without mesh implantation. The primary endpoint was incidence of incisional hernia, and the incidence of enterocutaneous fistula was a secondary endpoint.

Results: The incidence of enterocutaneous fistulas after wound closure post-fascial dehiscence (13% vs. 6% without and with mesh, respectively) or post-open abdomen (22% vs. 28% without and with mesh, respectively) was not significantly different. The incidence of incisional hernia was significantly lower with mesh implantation compared with no-mesh implantation in both contaminated (4% vs. 28%; p = 0.025) and dirty abdominal cavities (5% vs. 34%; p = 0.01).

Conclusions: Intra-abdominal contamination is not a contraindication for intra-abdominal mesh implantation. The incidence of enterocutaneous fistula is not elevated despite the presence of contamination. The rate of incisional hernias is significantly reduced after intraperitoneal mesh implantation for postoperative fascial dehiscence or open abdomen.

Citing Articles

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A prospective multicentre study evaluating the outcomes of the abdominal wall dehiscence repair using posterior component separation with transversus abdominis muscle release reinforced by a retro-muscular mesh: filling a step.

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Interrupted sutures prevent recurrent abdominal fascial dehiscence: a comparative retrospective single center cohort analysis of risk factors of burst abdomen and its recurrence as well as surgical repair techniques.

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Is there a role for prophylactic mesh in abdominal wall closure after emergency laparotomy? A systematic review and meta-analysis.

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PMID: 31641872 PMC: 7210219. DOI: 10.1007/s10029-019-02060-1.

Effectiveness of Prophylactic Intraperitoneal Mesh Implantation for Prevention of Incisional Hernia in Patients Undergoing Open Abdominal Surgery: A Randomized Clinical Trial.

Kohler A, Lavanchy J, Lenoir U, Kurmann A, Candinas D, Beldi G JAMA Surg. 2018; 154(2):109-115.

PMID: 30476940 PMC: 6439658. DOI: 10.1001/jamasurg.2018.4221.

References

Tremblay L, Feliciano D, Schmidt J, Cava R, Tchorz K, Ingram W . Skin only or silo closure in the critically ill patient with an open abdomen. Am J Surg. 2002; 182(6):670-5. DOI: 10.1016/s0002-9610(01)00805-4. View

Mingoli A, Puggioni A, Sgarzini G, Luciani G, Corzani F, Ciccarone F . Incidence of incisional hernia following emergency abdominal surgery. Ital J Gastroenterol Hepatol. 1999; 31(6):449-53. View

Bosscha K, Hulstaert P, Visser M, van Vroonhoven T, van der Werken C . Open management of the abdomen and planned reoperations in severe bacterial peritonitis. Eur J Surg. 2000; 166(1):44-9. DOI: 10.1080/110241500750009690. View

Sutton R, Bann S, Brooks M, Sarin S . The Surgical Risk Scale as an improved tool for risk-adjusted analysis in comparative surgical audit. Br J Surg. 2002; 89(6):763-8. DOI: 10.1046/j.1365-2168.2002.02080.x. View

Acosta S, Bjarnason T, Petersson U, Palsson B, Wanhainen A, Svensson M . Multicentre prospective study of fascial closure rate after open abdomen with vacuum and mesh-mediated fascial traction. Br J Surg. 2011; 98(5):735-43. DOI: 10.1002/bjs.7383. View

Brooks M, Sutton R, Sarin S . Comparison of Surgical Risk Score, POSSUM and p-POSSUM in higher-risk surgical patients. Br J Surg. 2005; 92(10):1288-92. DOI: 10.1002/bjs.5058. View

Burger J, Luijendijk R, Hop W, Halm J, Verdaasdonk E, Jeekel J . Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg. 2004; 240(4):578-83. PMC: 1356459. DOI: 10.1097/01.sla.0000141193.08524.e7. View

Bee T, Croce M, Magnotti L, Zarzaur B, Maish 3rd G, Minard G . Temporary abdominal closure techniques: a prospective randomized trial comparing polyglactin 910 mesh and vacuum-assisted closure. J Trauma. 2008; 65(2):337-42. DOI: 10.1097/TA.0b013e31817fa451. View

Esmat M . A new technique in closure of burst abdomen: TI, TIE and TIES incisions. World J Surg. 2006; 30(6):1063-73. DOI: 10.1007/s00268-005-0450-x. View

10.

Tsuei B, Skinner J, Bernard A, Kearney P, Boulanger B . The open peritoneal cavity: etiology correlates with the likelihood of fascial closure. Am Surg. 2004; 70(7):652-6. View

11.

Subramonia S, Pankhurst S, Rowlands B, Lobo D . Vacuum-assisted closure of postoperative abdominal wounds: a prospective study. World J Surg. 2009; 33(5):931-7. DOI: 10.1007/s00268-009-9947-z. View

12.

Madsen G, Fischer L, Wara P . Burst abdomen--clinical features and factors influencing mortality. Dan Med Bull. 1992; 39(2):183-5. View

13.

Mangram A, Horan T, Pearson M, Silver L, Jarvis W . Guideline for Prevention of Surgical Site Infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control. 1999; 27(2):97-132; quiz 133-4; discussion 96. View

14.

van Ramshorst G, Eker H, Harlaar J, Nijens K, Jeekel J, Lange J . Therapeutic alternatives for burst abdomen. Surg Technol Int. 2010; 19:111-9. View

15.

Mughal M, Bancewicz J, Irving M . 'Laparostomy': a technique for the management of intractable intra-abdominal sepsis. Br J Surg. 1986; 73(4):253-9. DOI: 10.1002/bjs.1800730405. View

16.

Balique J, Benchetrit S, Bouillot J, Flament J, Gouillat C, Jarsaillon P . Intraperitoneal treatment of incisional and umbilical hernias using an innovative composite mesh: four-year results of a prospective multicenter clinical trial. Hernia. 2004; 9(1):68-74. DOI: 10.1007/s10029-004-0300-z. View

17.

Cobb W, Carbonell A, Kalbaugh C, Jones Y, Lokey J . Infection risk of open placement of intraperitoneal composite mesh. Am Surg. 2009; 75(9):762-7. View

18.

Verdam F, Dolmans D, Loos M, Raber M, de Wit R, Charbon J . Delayed primary closure of the septic open abdomen with a dynamic closure system. World J Surg. 2011; 35(10):2348-55. PMC: 3170463. DOI: 10.1007/s00268-011-1210-8. View

19.

Teixeira P, Salim A, Inaba K, Brown C, Browder T, Margulies D . A prospective look at the current state of open abdomens. Am Surg. 2008; 74(10):891-7. DOI: 10.1177/000313480807401002. View

20.

Marwah S, Marwah N, Singh M, Kapoor A, Karwasra R . Addition of rectus sheath relaxation incisions to emergency midline laparotomy for peritonitis to prevent fascial dehiscence. World J Surg. 2005; 29(2):235-9. DOI: 10.1007/s00268-004-7538-6. View