Emergency incisional hernia repair: a difficult problem waiting for a solution

Area of Science:

• Surgical innovation
• Hernia repair techniques
• Wound management

Background:

• Emergency repair of incarcerated incisional hernias with bowel obstruction is complex in contaminated fields.
• High rates of post-operative infectious complications are associated with these procedures.
• Permanent prosthetic mesh use in these cases requires careful assessment of wound morbidity.

Purpose of the Study:

• To retrospectively assess wound-related morbidity from permanent prosthetic mesh use in emergency incarcerated incisional hernia repair with bowel obstruction.
• To describe a novel technique of secondary intention healing for exposed mesh.

Main Methods:

• A retrospective review of 60 patients undergoing emergency surgery for incarcerated incisional hernia with bowel obstruction and mesh placement (2000-2010).
• Comparison of outcomes between primary wound closure (55 patients) and secondary intention healing (5 patients) with mesh exposed.

Main Results:

• Primary wound closure group: 11 superficial SSIs, 5 deep wound infections, 1 cellulitis; one mesh removal.
• Secondary intention group: No infections observed.
• One mortality from septicemia in the secondary intention group.

Conclusions:

• Permanent prosthetic mesh use in emergency repair of incarcerated incisional hernias with bowel obstruction in contaminated fields is linked to a significant risk of wound infection.
• Secondary wound healing may reduce infectious complications but requires further investigation.
• Careful patient selection and wound management are crucial for mesh-based hernia repair.