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Application of a New Mesh Fixation Method in Laparoscopic Incisional Hernia Repair

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

Hasnain Zafar¹, Masooma Zaidi, Irfan Qadir

¹General Surgery Department, Aga Khan University Hospital, Stadium Road Karachi, Pakistan. muhamad_irfan_qadir@yahoo.com.

Annals of Surgical Innovation and Research

|January 6, 2012

Summary

Emergency repair of incarcerated incisional hernias with bowel obstruction using prosthetic mesh in contaminated fields carries a high risk of wound infection. Leaving the surgical wound open for secondary healing showed no infections, unlike primary closure.

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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.