Risk of Infection and Recurrence over Prolonged Follow up in Patients Undergoing Ventral Hernia Repair with Underlying Sepsis, Concomitant Bowel Injury or Resection - Can the Use of Synthetic Mesh be Justified?

Abstract

Introduction: The incidence of hernia in a laparotomy incision has been reported to reach up to 20% percent in clean, uncomplicated cases and believed to be higher in the setting of a contaminated operative field, and comorbidity. Objectives: The authors evaluated the risk of infection and hernia recurrence after repair with non-absorbable mesh. Methods: A retrospective review of outcome of all patients who underwent mesh repair for ventral hernias with underlying peritoneal sepsis or during a procedure with bowel anastomosis or repair. Long-term evaluation of outcome included intra-peritoneal or wound infection the need for mesh excision or recurrence and quality of life. Results: Patients with a recurrence (R) and those without a recurrence (NR) had similar, gender, BMI and ASA. The two groups were also comparable with regards to re-admission rate, peri-operative steroid use and the use of drains. A significantly greater proportion of (R) had hypertension, diabetes, and emergency surgery when compared with (NR). Conclusion: Frequency of mesh infection with the use of non-absorbable mesh in managing ventral hernia with underlying sepsis, during bowel resection or repair is similar to that during isolated ventral hernia repair with mesh.