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The single-staged approach to the surgical management of abdominal wall hernias in contaminated fields
D I Alaedeen1, J Lipman, D Medalie
1Department of Surgery, Division of General Surgery, University Hospitals of Cleveland, Case Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA. Michael.rosen@uhhs.com
Introduction:
The surgical treatment of large ventral hernias with accompanying contamination is challenging. We have reviewed our institution's experience with single-staged repair of complex ventral hernias in the setting of contamination.
Methods:
We retrospectively reviewed the medical records of all patients who underwent ventral hernia repairs in the setting of a contaminated field. Pertinent details included baseline demographics, reason for contamination, operative technique and details, postoperative morbidity, mortality and recurrence rates.
Results:
Between December 1999 and January 2006, 19 patients were identified with ventral hernia repairs performed in contaminated fields. There were 6 males and 13 females with a mean age of 61 years (40-82), ASA 3.2 (2-4), and BMI of 34 kg/m(2) (20-65). Fourteen patients had prior mesh: prolene (9), composix (3), goretex (1), and alloderm (1). Reasons for contamination included: mesh infection (14), enterocutaneous fistula (7), concomitant bowel resection (8), chronic non-healing wound (2), and necrotizing fasciitis (1). Operative approaches included primary repair (3), component separation without reinforcement (2), and with prosthetic reinforcement (9). In five patients the fascia could not be reapproximated in the midline and the defect was bridged with surgisis (1), Marlex (1), lightweight polypropylene (1) placed in the retrorectus space, and alloderm (2). Mean operative time was 260 min (90-600). Twelve postoperative complications occurred in nine (47%) patients and included wound infection (6), respiratory failure (1), ileus (2), postoperative hemorrhage (1), renal failure (1), and atrial fibrillation (1). One patient died in this series. During routine follow-up two recurrences were identified by physical exam.
Conclusions:
This study shows that single-stage treatment of ventral hernias in contaminated fields can be accomplished with a low recurrence rate and acceptable morbidity in these extremely challenging patients.
Insights
Surgical repair of complex ventral hernias in contaminated fields is challenging. This single-stage approach demonstrated a low recurrence rate and acceptable morbidity in high-risk patients.
Area of Science:
- Abdominal surgery
- Hernia repair
- Surgical outcomes
Background:
- Large ventral hernias with contamination present significant surgical challenges.
- Previous mesh complications, infections, and fistulas complicate repair.
- Contaminated fields increase the risk of morbidity and recurrence.
Purpose of the Study:
- To evaluate the feasibility and outcomes of single-stage ventral hernia repair in contaminated fields.
- To assess morbidity, mortality, and recurrence rates in this challenging patient population.
Main Methods:
- Retrospective review of 19 patients undergoing ventral hernia repair in contaminated fields (1999-2006).
- Data collected included demographics, contamination source, operative techniques, and postoperative outcomes.
- Analysis of complications, mortality, and recurrence rates.
Main Results:
- 19 patients (6 males, 13 females, mean age 61) underwent repair.
- Common contamination sources included mesh infection (14) and enterocutaneous fistula (7).
- Postoperative complications occurred in 47% of patients; two recurrences were identified.
Conclusions:
- Single-stage ventral hernia repair in contaminated fields is achievable.
- This approach offers a low recurrence rate and acceptable morbidity for complex cases.
- Careful patient selection and surgical technique are crucial for success.
