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Intraperitoneal mesh implantation for fascial dehiscence and open abdomen
Moritz Scholtes1, Anita Kurmann, Christian A Seiler
1Department of Visceral Surgery and Medicine, Bern University Hospital, University of Bern, 3010, Bern, Switzerland.
Background:
Postoperative fascial dehiscence and open abdomen are severe postoperative complications and are associated with surgical site infections, fistula, and hernia formation at long-term follow-up. This study was designed to investigate whether intraperitoneal implantation of a composite prosthetic mesh is feasible and safe.
Methods:
A total of 114 patients with postoperative fascial dehiscence and open abdomen who had undergone surgery between 2001 and 2009 were analyzed retrospectively. Contaminated (wound class 3) or dirty wounds (wound class 4) were present in all patients. A polypropylene-based composite mesh was implanted intraperitoneally in 51 patients, and in 63 patients the abdominal wall was closed without mesh implantation. The primary endpoint was incidence of incisional hernia, and the incidence of enterocutaneous fistula was a secondary endpoint.
Results:
The incidence of enterocutaneous fistulas after wound closure post-fascial dehiscence (13% vs. 6% without and with mesh, respectively) or post-open abdomen (22% vs. 28% without and with mesh, respectively) was not significantly different. The incidence of incisional hernia was significantly lower with mesh implantation compared with no-mesh implantation in both contaminated (4% vs. 28%; p = 0.025) and dirty abdominal cavities (5% vs. 34%; p = 0.01).
Conclusions:
Intra-abdominal contamination is not a contraindication for intra-abdominal mesh implantation. The incidence of enterocutaneous fistula is not elevated despite the presence of contamination. The rate of incisional hernias is significantly reduced after intraperitoneal mesh implantation for postoperative fascial dehiscence or open abdomen.
Insights
Intraperitoneal mesh implantation significantly reduces incisional hernia rates following fascial dehiscence or open abdomen. This approach is safe, even in contaminated wounds, without increasing enterocutaneous fistula incidence.
Area of Science:
- Abdominal Surgery
- Surgical Complications
- Wound Management
Background:
- Postoperative fascial dehiscence and open abdomen are severe complications.
- These conditions increase risks of surgical site infections, fistulas, and long-term hernias.
- Investigating intraperitoneal mesh implantation for feasibility and safety is crucial.
Purpose of the Study:
- To evaluate the safety and efficacy of intraperitoneal composite prosthetic mesh implantation.
- To compare outcomes of mesh implantation versus no mesh in managing fascial dehiscence and open abdomen.
- To assess the incidence of incisional hernias and enterocutaneous fistulas.
Main Methods:
- Retrospective analysis of 114 patients with fascial dehiscence or open abdomen (2001-2009).
- Patients had contaminated (wound class 3) or dirty (wound class 4) wounds.
- Comparison between intraperitoneal mesh implantation (n=51) and no mesh (n=63).
Main Results:
- Incisional hernia incidence was significantly lower with mesh (4-5%) versus no mesh (28-34%) in contaminated/dirty cavities.
- No significant difference in enterocutaneous fistula rates between mesh (6-28%) and no-mesh (13-22%) groups.
- Mesh implantation demonstrated a significant reduction in incisional hernias.
Conclusions:
- Intra-abdominal mesh implantation is feasible and safe, even with intra-abdominal contamination.
- Contamination does not elevate the risk of enterocutaneous fistulas with mesh use.
- Intraperitoneal mesh significantly reduces incisional hernia rates in fascial dehiscence and open abdomen cases.
