Abstract
Objective
In patients with postoperative wound dehiscence in the presence of infection, extensive visceral oedema often necessitates mechanical containment of bowel. Prosthetic mesh is often used for this purpose. The aim of the present study was to assess the safety of the use of non-absorbable and absorbable meshes for this purpose.
Method
All patients that had undergone mesh repair of abdominal wound dehiscence between January 1988 and January 1998 in the presence of intra-abdominal infection were included in a retrospective cohort study. All surviving patients had physical follow-up in February 2001.
Result
Eighteen patients were included in the study. Meshes consisted of polyglactin (n = 6), polypropylene (n = 8), polyester (n = 1), or a combination of a polypropylene mesh with a polyglactin mesh on the visceral side (n = 3). All patients developed complications, consisting mainly of mesh infection (77%), intra-abdominal abscess (17%), enterocutaneous fistula (17%), or mesh migration through the bowel (11%). Mesh removal was necessary in eight patients (44%). Within four months postoperatively, six patients (33%) had died because of progressive abdominal sepsis. The incidence of progressive abdominal sepsis was significantly higher in the group with absorbable polyglactin mesh than in the group with nonabsorbable mesh (67 vs. 11%, p = 0.02) After a mean follow-up of 49 months, 63% of the surviving patients had developed incisional hernia. Absorbable meshes did not yield better outcomes than nonabsorbable meshes in terms of complications and mortality rate.
Conclusion
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.
Similar content being viewed by others
References
Riou JPA, Cohen JR, Johnson H (1992) Factors influencing wound dehiscence. Am J Surg 163:324–330
Muckart JM, Luvuno FM (1985). Abdominal wound disruption. J R Coll Surg 30:47–49
Van ‘t Riet M, De Vos van Steenwijk PJ, Bonjer HJ, Steyerberg EW, Jeekel J (2004) Incisional hernia after repair of wound dehiscence: incidence and risk factors. Am Surg 70:281–286
Voyles CR, Richardson JD, Bland KI, Tobin GR, Flint LM, Polk HC (1981) Emergency abdominal wall reconstruction with polypropylene mesh. Ann Surg 194:219–23
Stone HH, Fabian TC, Turkleson ML, Jurkiewicz MJ (1981) Management of acute full-thickness losses of the abdominal wall. Ann Surg 193:612–618
Boyd WC (1977) Use of Marlex mesh in acute loss of the abdominal wall due to infection. Surg Gynecol Obstet 144:251–252
Wouters DB, Krom RAF, Slooff MJH (1983) The use of Marlex mesh in patients with generalized peritonitis and multiple organ system failure. Surg Gynecol Obstet 156:909–914
Buck JR, Fath JJ, Siu-Keung Chung MPH, Sorensen VJ, Horst HM, Obeid FN (1995) Use of absorbable mesh as an aid in abdominal wall closure in the emergent setting. Am Surg 61:655–658
Porter JM. (1995) A combination of Vicryl and Marlex mesh: a technique for abdominal wall closure in difficult cases. J Trauma 39:1178–1180
Dayton MT, Buchele BA, Shirazi SS, Hunt LB (1986) Use of an absorbable mesh to repair contaminated abdominal wall defects. Arch Surg 121:954–960
Greene MA, Mullins RJ, Malangoni MS, Feliciano PD, Richardson JD, Polk HC Jr (1993) Laparotomy wound closure with absorbable polyglycolic acid mesh. Surg Gynaecol Obstet 176:213–218
Mc Neeley SG jr, Hendrix SL, Bennett SM, Singh A, Ransom SB, Kmak DC, Morley GW (1998) Synthetic graft placement in the treatment of fascial dehiscence with necrosis and infection. Am J Obstet Gynaecol 179:1430–1435
Brandt CP, McHenry CR, Jacobs DG, Piotrowski JJ, Priebe PP (1995) Polypropylene mesh closure after emergency laparotomy: morbidity and outcome. Surgery 118:736–741
Turkcapar AG, Yerdel MA, Aydinuraz K, Bayar S, Kuterdem E (1998) Repair of midline incisional hernias using polypropylene grafts. Surg Today 28:59–63
Kendrick JH, Casali RE, Lang NP, Read RC (1982) The complicated septic abdominal wound. Arch Surg 117:464–468
Gilsdorf RB, Shea MM (1975). Repair of massive septic abdominal wall defects with Marlex mesh. Am J Surg 130:634–638
Jones JW, Jurkovich GJ (1989) Polypropylene mesh closure of infected abdominal wounds. Am Surg 55:73–76
Nagy KK, Fildes JJ, Mahr C, Roberts RR, Frosner SM, Joseph KT, Barrett J (1996) Experience with three prosthetic materials in temporary abdominal wall closure. Am Surg 62: 331–335
Emmink B, Thomson SR, Moodley M, Muckart DJJ (1993) Laparotomy closure using perisplenic polyglactin mesh. J R Coll Surg Edinb 38:177–178
Levasseur JC, Lehn E, Rignier P (1979) Repair of extensive eviscerations using an absorbable prosthesis. J Chir 116:737–739
Osther PJ, Gjode P, Mortensen BB, Mortensen PB, Bartholin J, Gottup F (1995) Randomized comparion of polyglycolic acid and polyglyconate sutures for abdominal fascial closure after laparotomy in patients with suspected impaired wound healing. Br J Surg 82:1080–1082
Stol DW (1978) De invloed van hechtmaterial of de wondgenezing. Thesis, Davids Decor, Alblasserdam
Wissing JC (1988) Het sluitstuk van de laparotomie. Een proscpectief gerandomiseerd multicentre onderzoek naar de resultaten van fasciesluiting. Thesis, Helmond, Wibrodissertatiedrukkerij
Koniaris LG, Hendrickson RJ, Drugas G, Abt P, Schoeniger LO (2001) Dynamic retention. A technique for closure of the complex abdomen in critically ill patients. Arch Surg 136:1359–1363
Ghimenton F, Thomson SR, Muckart DJ, Burrows R (2000) Abdominal content containment: practicalities and outcome. Br J Surg 87:106–109
Smith PC, Tweddell JS, Bessey PQ (1992) Alternative approaches to abdominal wound closure in severely injured patients with massive visceral edema. J Trauma 32:16–20
Bender JS, Bailey CE, Saxe JM, Ledgerwood AM, Lucas CE (1994). The technique of visceral packing: recommended management of difficult fascial closure in trauma patients. J Trauma 36:182–185
Sherck J, Seiver A, Shateney C, Oakes D, Cobb L (1998) Covering the open abdomen: a better technique. Am Surg 64:854–857
Miller PR, Thompson JT, Flaer BJ, Meredith JW, Chang MC (2002) Late fascial closure in lieu of ventral hernia: the next step in open abdomen management. J Trauma 53:843–849
Erdmann D, Drye C, Heller LBSN, Wong MS, Levin LS (2001) Abdominal wall defect and enterocutaneous fistula treatment with the vacuum-assisted closure (VAC system). Plast Reconst Surg 108:2066–2068
Catena F, Ansaloni L, Gazzotti F, Gagliardi S, Di Saverio S, D’Alessandro L, Pinna AD (2007) Use of porcine dermal collagen (Permacol) for hernia repair in contaminated fields. Hernia 11:57–60
Alaedeen DI, Lipman J, Medalie D, Rosen MJ (2007) The single-staged approach to the surgical management of abdominal wall hernias in contaminated fields. Hernia 11:41–45
Patton JH Jr, Berry S, Kralovich KA (2007) Use of human acellular dermal matrix in complex and contaminated abdominal wall reconstructions. Am J Surg 193:360–363
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
van’t Riet, M., van Steenwijk, P.J.d., Bonjer, H.J. et al. Mesh repair for postoperative wound dehiscence in the presence of infection: is absorbable mesh safer than non-absorbable mesh?. Hernia 11, 409–413 (2007). https://doi.org/10.1007/s10029-007-0240-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10029-007-0240-5