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The treatment of incisional and abdominal hernia with a prosthesis in potentially infected tissues — A series of 47 cases

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The aim of this study was to assess the infective risks involved in the placement of a non-absorbable prosthesis in the abdominal wall, in the treatment of abdominal hernias. Two groups of patients were compared over the period 1985 to 1995. Group A (N=47) received non-absorbable (Mersilene) prostheses, placed in a potentially infected area (Altemeier class 2, 3 and 4). Group B (N=47, Altemeier class 1) comprised a similar group of patients to those in group A. The prostheses were usually placed in the retro-muscular prefascial plane. Antibiotics were given either prophylactically or therapeutically, according to the degree of sepsis surrounding the operation. The length of hospital stay was longer in group A (15.6 ± 9 as against 10 ± 6 days. p=0,0006). There were two deaths in group A and none in group B (not significant). The general complication rate was 23.7% in group A as against 8.5% in group B (p=0.016). There was no significant difference between the two groups in regard to surgical complications (group A 23.7%, group B 21.3%). The infection rate in the abdominal wall was 10.6% and 6.4% in groups A and B respectively (not significant). There was only one patient with a prosthetic infection (in group A) requiring revision. We conclude that the use of non-absorbable prostheses placed in the retromuscular prefascial space may be more widely employed, in the course of potentially contaminated intra-abdominal surgery of Altemeier class 2.

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Vix, J., Meyer, C., Rohr, S. et al. The treatment of incisional and abdominal hernia with a prosthesis in potentially infected tissues — A series of 47 cases. Hernia 1, 157–161 (1997).

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