Incisional Hernia Repair in Contaminated Surgical fields (I.H.R.C.S.) study using biological prostheses in emergency surgery setting with contaminated hernias: a multicenter prospective observational study

https://doi.org/10.4081/joper.2016.26

Authors

  • Belinda De Simone | desimone.belinda@gmail.com Department of Emergency and Trauma Surgery, University Hospital of Parma, Parma, Italy.
  • Fausto Catena Department of Emergency and Trauma Surgery, University Hospital of Parma, Parma, Italy.
  • Antonio Biondi Department of General Surgery, University Hospital of Catania, Catania, Italy.
  • Gianluca Baiocchi Department of General Surgery, Riuniti Hospital of Brescia, Brescia, Italy.
  • Fabio Campanile Department of General Surgery, Civita Castellana’s Hospital, Viterbo, Italy.
  • Federico Coccolini Department of Emergency and General Surgery, Papa XXIII Hospital, Bergamo, Italy.
  • Mario Testini Department of General Surgery, University Hospital of Bari, Bari, Italy.
  • Salomone Di Saverio Department of Emergency and General Surgery, Maggiore Hospital, Bologna, Italy.
  • Massimo Sartelli Department of Emergency and General surgery, Macerata’s Hospital, Macerata, Italy.
  • Arianna Heyer Department of Medical Sciences, University of California, Berkeley, CA, United States.
  • Luca Ansaloni Department of Emergency and General Surgery, Papa XXIII Hospital, Bergamo, Italy.

Abstract

There are still difficulties to find appropriate indication for prosthetic implant in hernia surgery in contaminated surgical fields. Biologic prosthetic materials have been developed and proposed for the clinical use in contaminated surgical fields with interesting outcomes. The aim of this study is to analyze data from nine Italian Emergency Surgery Units concerning patients consecutively admitted with diagnosis of strangulated incisional hernia (IH), submitted to surgery in emergency and treated with biological prostheses. This is a prospective observational study. Subjects submitted to singlestaged IH repair in a contaminated surgical field, with the use of biologic mesh, were prospectively studied over a 1-year time period. All patients enrolled in this study were submitted to bowel/intestinal resection at the same operative time for perforation. Primary end points of our study were wound complication and hernia recurrence. Seventy-one patients were enrolled (F=21, M=50); the mean age was 69.2±11.1 standard deviation (SD) years and the mean American Society of Anesthesiologist (ASA) score was 3.1±0.8 SD. Twenty-one patients (29.57%) had a wound complication, associated with high ASA score, diabetes, smoking, chronic immunosuppression, number of previous hernia repairs, dirty surgical field, sublay extra peritoneal mesh placement and no anterior fascia closure. After a mean follow up time of 27.2 months, hernia recurrence occurred in 19 patients (26.76%). Predictors of hernia recurrence included wound complications, high ASA score, diabetes, chronic immunosuppression, dirty surgical field and sublay extra peritoneal mesh placement. Use of biological prostheses in contaminated fields is safe with favorable medium term recurrence rate (26.76% in our experience). Surgical technique performed is important to decrease hernia recurrence rate.

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Published
2016-11-07
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Original Articles
Keywords:
Incisional hernia repair, hernia recurrence., biologic mesh, contaminated surgical field, mesh repair, wound infection, hernia recurrence
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How to Cite
1.
De Simone B, Catena F, Biondi A, Baiocchi G, Campanile F, Coccolini F, Testini M, Di Saverio S, Sartelli M, Heyer A, Ansaloni L. Incisional Hernia Repair in Contaminated Surgical fields (I.H.R.C.S.) study using biological prostheses in emergency surgery setting with contaminated hernias: a multicenter prospective observational study. J Peritoneum [Internet]. 2016Nov.7 [cited 2020Aug.10];1(2). Available from: http://www.jperitoneum.org/index.php/joper/article/view/26

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