Mesh repair for postoperative wound dehiscence in the presence of infection: is absorbable mesh safer than non-absorbable mesh?

Riet, M. van’t; Steenwijk, Peggy J. de Vos van; Bonjer, H. Jaap; Steyerberg, Ewout W.; Jeekel, J.

doi:10.1007/s10029-007-0240-5

Cited by 71 publications

(34 citation statements)

References 21 publications

(21 reference statements)

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“…7 Van't Riet showed that any type of wound dehiscence led to an incisional hernia in 63% of patients at 4-years of followup. 8 Many hernia repair methods have been described. Traditional primary repair entails a laparotomy with suture approximation of strong fascial tissue on each side of the defect.…”

Section: Introductionmentioning

confidence: 99%

Incisional hernia: preliminary observations at a new institute

Huda

Kumar

2017

Int Surg J

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Background: Ventral hernia develops when an area of the abdominal wall weakens and develops a tear or hole. It may develop as a defect at birth, resulting from incomplete closure of a part of the abdominal wall, or develop where an incision was made during an abdominal surgery, occurring when the incision doesn't heal properly. Incisional hernia is typically observed within the first 5 years after the surgical incision is made, but may develop long afterwards.1 This study was undertaken to review the history and clinical presentations in patients with incisional hernia, and subsequent treatment. Methods: In the present study, the first 20 cases of incisional hernia admitted to this institute for elective herniorrhaphy were studied. History of the previous surgery was obtained and the findings noted. Treatment carried out was included in the study. Results: Out of 20 cases, 12 were female (60%). Mean age of the patient was 41.9±11.9 years. Lower segment Caesarian section was the commonest preceding surgery (7 out of 12 females; 58.33%). Exploratory laparotomy accounted for 5 out of 8 cases amongst males (62.5%). Commonest site of the hernia was infraumbilical (n=9; 45%). Average size of the defect was 6.2 cm x 5.6 cm. 13 patients underwent surgery. Laparoscopic ventral hernia repair was the most common modality used (10 out of 13; 76.9%). Conclusions: Incisional hernia is more common in females, and gynaecological operations are most common cause and most common site is infraumbilical.

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Section: Introductionmentioning

confidence: 99%

Incisional hernia: preliminary observations at a new institute

Huda

Kumar

2017

Int Surg J

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“…The sample size was calculated using the difference in the primary end point of morbidity, which is expected to be 60% in arm B [11-13] and 30% in arm A.…”

Section: Methodsmentioning

confidence: 99%

Use of biological mesh versus standard wound care in infected incisional ventral hernias, the SIMBIOSE study: a study protocol for a randomized multicenter controlled trial

Mariette¹,

Briez²,

Deniès³

et al. 2013

Trials

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BackgroundIn infected incisional ventral hernias (IVHs), the use of a synthetic non-absorbable mesh is not recommended and biological meshes hold promise. However, the level of evidence for their safety and efficacy remains low.MethodsThe SIMBIOSE trial is a multicenter, phase III, randomized, controlled trial comparing the use of a biological mesh versus traditional wound care in patients with an IVH. The primary end point is 6-month infectious and/or wound morbidity. Secondary end points are wound infection and recurrent hernia rates, post-operative pain, quality of life, time to heal, reoperation need, impact of the cross-linked mesh structure, and a medico-economic evaluation. One hundred patients need to be included.ResultsThe main results expected with biological mesh use are a significant decrease of post-operative morbidity, hernia recurrence, time to heal, and costs with an improved quality of life.ConclusionsFor the first time, the impact of biological meshes in the treatment of IVHs will be evaluated in an academic, randomized, phase III trial to provide scientific evidence ( NCT01594450).Trial registrationClinicalTrial.gov, NCT01594450

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“…Use of absorbable mesh is discouraged by the high incidence of incisional hernias in the longterm [64] . In contaminated/dirty fields, other methods such as NPWT or dynamic wound closure systems are more appropriate [65] . The usefulness and long-term results of biological implants is uncertain and are not recommended in cases of large bacterial inocula [28] ; (3) Patients within the 2-3 wk time window with incomplete unintentional acute POAW and partially non-adherent bowel loops/abdominal wall and without enteroatmospheric fistula are candidates for a definitive early progressive abdominal wall closure in the same way as planned acute POAW; (4) evisceration/fascial dehiscence and the open abdomen are viewed as different and unrelated processes, possibly because the first is considered a complication of surgery [41,43] and the second as a procedure of surgery [1,3] .…”

Section: Treatment Optionsmentioning

confidence: 99%

“Acute postoperative open abdominal wall”: Nosological concept and treatment implications

López-Cano

Pereira

Armengol

2013

WJGS

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The so-called "burst abdomen" has been described for many years and is a well-known clinical condition, whereas the concept of the "open abdomen" is relatively new. In clinical practice, both nosological entities are characterized by a complex spectrum of symptoms apparently disconnected, which in many cases poses a great challenge for surgical repair. In order to assess the management of these disorders in a more comprehensive and integral fashion, the concept of "acute postoperative open abdominal wall" (acute POAW) is presented, which in turn can be divided into "intentional" or planned acute POAW and "unintentional" or unplanned POAW. The understanding of the acute POAW as a single clinical process not only allows a better optimization of the therapeutic approach in the surgical repair of abdominal wallrelated disorders, but also the stratification and collection of data in different patient subsets, favoring a better knowledge of the wide spectrum of conditions involved in the surgical reconstruction of the abdominal wall.

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Mesh repair for postoperative wound dehiscence in the presence of infection: is absorbable mesh safer than non-absorbable mesh?

Abstract: Synthetic graft placement in the presence of intra-abdominal infection has a high risk of complications, regardless of whether absorbable (polyglactin) or non-absorbable mesh material (polypropylene or polyester) is used, and should be avoided if possible.

Cited by 71 publications

References 21 publications

Incisional hernia: preliminary observations at a new institute

Incisional hernia: preliminary observations at a new institute

Use of biological mesh versus standard wound care in infected incisional ventral hernias, the SIMBIOSE study: a study protocol for a randomized multicenter controlled trial

“Acute postoperative open abdominal wall”: Nosological concept and treatment implications

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