The Use of Prosthetic Mesh in the Emergency Management of Acute Incarcerated Inguinal Hernias

Abstract

Introduction. Tension-free hernia repair has been regarded as a gold standard treatment for selected inguinal hernias, but the use of prosthetic mesh in acute incarcerated inguinal hernias is controversial. Our study focused on evaluating the safety and efficacy of the prosthetic mesh repair for emergency cases. Methods. Patients with acute incarcerated inguinal hernias who underwent emergency prosthetic mesh repair during 2009 to 2014 at our department were included. Patient characteristics, operative approaches and results, and complications were retrospectively analyzed. Results. A total of 167 patients were included in our study. One hundred and twenty-two patients underwent open surgery while the remaining 45 patients underwent transabdominal preperitoneal laparoscopic approach. The hernia was indirect inguinal in 133 patients (79.6%), direct inguinal in 15 patients (9.0%), and femoral in 19 patients (11.4%). The overall wound infection rate of these patients was 3%. Nonviable intestinal resection was performed in 25 patients (8.4%), only 2 of whom underwent wound infection. Another 3 patients who developed wound infection had viable hernia content. There was no mesh-related infection. There was no statistically significant difference in wound infection rates between patients with viable hernia contents and those with nonviable contents (P < .05). Conclusion. The use of the prosthetic mesh in the treatment of acute incarcerated inguinal hernia is safe and effective. Nonviable intestinal resection cannot be regarded as a contradiction of the mesh repair.

A Single-Arm Clinical Study Assessing Safety and Effectiveness of Path Removal for Delayed Patch Infection After Inguinal Hernioplasty

“…[13] Mesh infection is a major cause of inguinal hernia repair failure [14][15]. The results showed that the incidence of patch-related infection after tension-free repair of inguinal hernia was 0.6%-8.0% [16][17][18]. The total infection rate of laparoscopic herniorrhaphy was 0.7%-2%, which was related to the nonstandard aseptic operation, incomplete hemostasis, and contamination of the Mesh itself [19].…”

A retrospective cohort study of open preperitoneal repair versus open suture repair for the treatment of emergency femoral hernia

“…At present, the use of a mesh for the tension-free repair of an emergency hernia does not seem to be an absolute contraindication 11 . A mesh is safe to apply even in cases of intestinal resection and anastomosis 10,[17][18][19][20] . Evidence has accumulated regarding the application of synthetic meshes, and clinicians recommend the use of synthetic meshes to repair FHs in patients, including in emergency situations 2,10,19 .…”