Use of prosthetic mesh in complicated incisional hernias

Incisional hernia (IH) repair with conventional techniques is associated with high recurrence rate. Surgical repair using prosthetic biomaterials is becoming increasingly popular. On the basis of the good results an increasing number of surgeons have begun to use this technique. However prosthesis use in contaminated fields is still debated. In complicated IH contaminating surgical procedure are often performed and the use of meshes can be hazardous. The aim of this study was to report our experience about the treatment of complicated IH with prosthetic materials in an emergency surgery setting.

From November 1995 to November 2001 55 patients were submitted to emergency surgical treatment for complicated IH. Eleven patients were treated using a prosthetic device. Patients mean age was 71.3 (range 38-91). About 70% of patients had concomitant major cardiac or pulmonary diseases.

Thirty-two IH were strangulated, 23 were incarcerated. In all patients a viscerolysis was carried out. In 6 patients a small bowel resection was done and in 4 subjects a large bowel resection was performed. Eight patients were submitted to omental resection. There were not differences in morbidity and mortality between the studied group. Recurrence rate was significantly lower in prosthetic treated group.

We concluded that prosthetic repair of complicated IH is feasible in selected cases allowing abdominal wall anatomy re-establishment.