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Polypropylene mesh closure after emergency laparotomy: morbidity and outcome
C P Brandt1, C R McHenry, D G Jacobs
1Department of Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio 44109-1998, USA.
Surgery
|October 1, 1995
Summary
Polypropylene mesh offers an effective alternative for emergency abdominal wall closure after laparotomy. Interposing omentum prevents fistulas, and skin flaps ensure better wound healing.
Area of Science:
- Surgical innovation
- Abdominal surgery
- Wound healing
Background:
- Emergency laparotomy often requires alternative abdominal wall closure methods.
- Assessing morbidity and outcomes of polypropylene mesh for fascial closure is crucial.
Purpose of the Study:
- To determine the morbidity and outcome of emergency fascial closure using polypropylene mesh.
Main Methods:
- Retrospective review of 70 patients undergoing emergency fascial closure with polypropylene mesh (1990-1994).
- Analysis of indications for mesh placement, complication rates, and wound closure techniques.
Main Results:
- Indications included visceral edema (40), infected fascia (21), and planned reexploration (7).
- Enteric fistulas occurred in 7.1% but were eliminated by interposing omentum (0/51 vs 5/19, p<0.01).
- Survival with wound closure was 60%; skin flaps resulted in fewer complications (1/19) compared to skin grafting or secondary healing (9/17, p<0.01).
Conclusions:
- Polypropylene mesh is effective for abdominal closure post-emergency laparotomy, even with sepsis.
- Omental interposition prevents mesh-related fistulas.
- Full-thickness skin flaps are preferred for soft tissue coverage over mesh.