Document Detail


Mesh repair for postoperative wound dehiscence in the presence of infection: is absorbable mesh safer than non-absorbable mesh?
MedLine Citation:
PMID:  17551808     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: In patients with postoperative wound dehiscence in the presence of infection, extensive visceral oedema often necessitates mechanical containment of bowel. Prosthetic mesh is often used for this purpose. The aim of the present study was to assess the safety of the use of non-absorbable and absorbable meshes for this purpose. METHOD: All patients that had undergone mesh repair of abdominal wound dehiscence between January 1988 and January 1998 in the presence of intra-abdominal infection were included in a retrospective cohort study. All surviving patients had physical follow-up in February 2001. RESULT: Eighteen patients were included in the study. Meshes consisted of polyglactin (n = 6), polypropylene (n = 8), polyester (n = 1), or a combination of a polypropylene mesh with a polyglactin mesh on the visceral side (n = 3). All patients developed complications, consisting mainly of mesh infection (77%), intra-abdominal abscess (17%), enterocutaneous fistula (17%), or mesh migration through the bowel (11%). Mesh removal was necessary in eight patients (44%). Within four months postoperatively, six patients (33%) had died because of progressive abdominal sepsis. The incidence of progressive abdominal sepsis was significantly higher in the group with absorbable polyglactin mesh than in the group with nonabsorbable mesh (67 vs. 11%, p = 0.02) After a mean follow-up of 49 months, 63% of the surviving patients had developed incisional hernia. Absorbable meshes did not yield better outcomes than nonabsorbable meshes in terms of complications and mortality rate. CONCLUSION: Synthetic graft placement in the presence of intra-abdominal infection has a high risk of complications, regardless of whether absorbable (polyglactin) or non-absorbable mesh material (polypropylene or polyester) is used, and should be avoided if possible.
Authors:
M van't Riet; P J de Vos van Steenwijk; H J Bonjer; E W Steyerberg; J Jeekel
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Publication Detail:
Type:  Journal Article     Date:  2007-06-06
Journal Detail:
Title:  Hernia : the journal of hernias and abdominal wall surgery     Volume:  11     ISSN:  1265-4906     ISO Abbreviation:  Hernia     Publication Date:  2007 Oct 
Date Detail:
Created Date:  2007-09-27     Completed Date:  2008-02-27     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9715168     Medline TA:  Hernia     Country:  France    
Other Details:
Languages:  eng     Pagination:  409-13     Citation Subset:  IM    
Affiliation:
Department of Surgery, University Hospital Rotterdam, Dr Molewaterplein 40, 3015, GD Rotterdam, The Netherlands. mvantriet@hotmail.com
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MeSH Terms
Descriptor/Qualifier:
Abdomen / surgery
Absorbable Implants*
Adult
Aged
Aged, 80 and over
Cohort Studies
Female
Humans
Male
Middle Aged
Polyglactin 910*
Polypropylenes*
Retrospective Studies
Surgical Mesh*
Surgical Wound Dehiscence / etiology,  therapy*
Surgical Wound Infection / etiology,  therapy*
Treatment Outcome
Chemical
Reg. No./Substance:
0/Polypropylenes; 34346-01-5/Polyglactin 910

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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