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Updated: Feb 24, 2026
Laparoscopic Repair of Para-Esophageal Hernia Using Absorbable Biosynthetic Mesh
Published on: September 11, 2021
Mesh Safety Under Contamination Across Incarcerated Hernias: A Single-Center Cohort Analysis With a Systematic Review
1General Surgery Department, Nanping First Hospital Affiliated to Fujian Medical University, Nanping, China.
Abstract:
BackgroundWhether prosthetic mesh increases infection in contaminated fields remains controversial, particularly in incarcerated hernias and adult Bochdalek hernia (BH) with gastric pathology.MethodsWe combined a PRISMA-guided systematic review of adult BH with gastric pathology (14 cases, 1981-2025) with a single-center retrospective cohort of incarcerated hernias treated laparoscopically or laparoscopy-assisted (n = 313; inguinal 177, incisional 111, diaphragmatic 10 [4 BH, 1 Morgagni], and hiatal 15). Pure open repairs were excluded. Intraoperative findings were stratified as clean, mild, or severe contamination. Primary endpoint: 3-month infectious outcomes (surgical site infection, intra-abdominal abscess, and mesh infection) comparing mesh vs non-mesh repair. A representative BH case with gastric antral perforation managed by one-stage gastric repair and mesh-reinforced diaphragmatic closure is presented.ResultsAmong clean cases receiving mesh, the 3-month infection rate was 1.5% (3/198). In mild contamination, mesh did not increase infection compared with non-mesh repair (10.0% [4/40] vs 6.7% [3/45]; RR 1.50, 95% CI 0.36-6.30; P = .702). In severe contamination, infection rates were also similar (21.4% [3/14] vs 18.8% [3/16]; RR 1.14, 95% CI 0.27-4.78; P = 1.000). The BH review showed 57.1% gastric volvulus and 42.9% perforation/necrosis; mesh was used selectively (21.4%) in staged or clean settings, and 37.5% of female cases occurred during pregnancy.ConclusionsIn this laparoscopic-dominant cohort, mesh repair after meticulous lavage was not associated with higher 3-month infection across contamination strata and appeared safe in selected severely contaminated cases. These findings support a contamination-aware, selective mesh strategy within a CT-first, laparoscopy-first pathway and warrant prospective validation, particularly for open repairs and longer follow-up.
Insights
Prosthetic mesh use in hernia repair, even in contaminated surgical fields, did not increase infection rates. This study supports a selective mesh strategy in laparoscopic hernia repair across contamination levels.
Area of Science:
- Abdominal Surgery
- Surgical Innovation
- Hernia Repair Techniques
Background:
- The use of prosthetic mesh in contaminated surgical fields for hernia repair remains a subject of debate.
- Specific concerns exist regarding incarcerated hernias and adult Bochdalek hernias (BH) with gastric pathology.
Purpose of the Study:
- To evaluate the association between prosthetic mesh use and infectious outcomes in incarcerated hernias and adult Bochdalek hernias (BH) with gastric pathology.
- To compare infection rates (surgical site infection, intra-abdominal abscess, mesh infection) between mesh and non-mesh repairs across different contamination levels.
Main Methods:
- A systematic review adhering to PRISMA guidelines for adult BH with gastric pathology (14 cases).
- A retrospective cohort study of 313 patients undergoing laparoscopic or laparoscopy-assisted incarcerated hernia repair.
- Intraoperative findings were stratified into clean, mild, or severe contamination categories.
Main Results:
- In clean cases, mesh repair had a 3-month infection rate of 1.5%.
- In mild contamination, mesh vs. non-mesh repair showed similar infection rates (10.0% vs. 6.7%, P = .702).
- In severe contamination, infection rates were also comparable (21.4% vs. 18.8%, P = 1.000).
- The BH review identified high rates of gastric volvulus (57.1%) and perforation/necrosis (42.9%).
Conclusions:
- Laparoscopic mesh repair, following thorough lavage, was not linked to increased 3-month infection rates across contamination strata.
- Mesh repair appears safe in selected severely contaminated cases.
- Findings support a contamination-aware, selective mesh strategy in laparoscopic hernia repair, warranting prospective validation.
