The Great Debate: Mesh or No Mesh in Contaminated Hernia Repairs?

Area of Science:

• General Surgery
• Biomaterials Science

Background:

• Mesh utilization is standard in abdominal hernia repair for durability and reduced recurrence.
• Contaminated hernia repairs pose challenges due to increased mesh infection risks.

Purpose of the Study:

• To evaluate the efficacy and safety of lightweight macroporous polypropylene meshes in abdominal hernia repair, particularly in contaminated settings.
• To compare outcomes of mesh repair versus primary suture repair in contaminated fields.

Main Methods:

• Review of studies comparing macroporous polypropylene meshes with primary suture repair and other mesh types.
• Analysis of mesh use in retrorectus plane for contaminated repairs.
• Assessment of evidence regarding postoperative complications and infection rates.

Main Results:

• Macroporous polypropylene meshes show potential for reduced surgical site infections and lower recurrence rates compared to primary suture repair.
• Favorable salvage rates observed with macroporous polypropylene mesh in the retrorectus plane for contaminated repairs.
• Conflicting evidence suggests increased postoperative complications, including infection, with mesh use in clean-contaminated or contaminated fields.

Conclusions:

• The benefit of reduced recurrence risk with mesh use in contaminated hernia repairs may be outweighed by increased infection risk and morbidity.
• Further prospective research with long-term follow-up is needed to establish optimal strategies for contaminated hernia repairs and guide evidence-based practice.