Abstract
Introduction
The surgical treatment of large ventral hernias with accompanying contamination is challenging. We have reviewed our institution's experience with single-staged repair of complex ventral hernias in the setting of contamination.
Methods
We retrospectively reviewed the medical records of all patients who underwent ventral hernia repairs in the setting of a contaminated field. Pertinent details included baseline demographics, reason for contamination, operative technique and details, postoperative morbidity, mortality and recurrence rates.
Results
Between December 1999 and January 2006, 19 patients were identified with ventral hernia repairs performed in contaminated fields. There were 6 males and 13 females with a mean age of 61 years (40–82), ASA 3.2 (2–4), and BMI of 34 kg/m2 (20–65). Fourteen patients had prior mesh: prolene (9), composix (3), goretex (1), and alloderm (1). Reasons for contamination included: mesh infection (14), enterocutaneous fistula (7), concomitant bowel resection (8), chronic non-healing wound (2), and necrotizing fasciitis (1). Operative approaches included primary repair (3), component separation without reinforcement (2), and with prosthetic reinforcement (9). In five patients the fascia could not be reapproximated in the midline and the defect was bridged with surgisis (1), Marlex (1), lightweight polypropylene (1) placed in the retrorectus space, and alloderm (2). Mean operative time was 260 min (90–600). Twelve postoperative complications occurred in nine (47%) patients and included wound infection (6), respiratory failure (1), ileus (2), postoperative hemorrhage (1), renal failure (1), and atrial fibrillation (1). One patient died in this series. During routine follow-up two recurrences were identified by physical exam.
Conclusions
This study shows that single-stage treatment of ventral hernias in contaminated fields can be accomplished with a low recurrence rate and acceptable morbidity in these extremely challenging patients.
Similar content being viewed by others
References
Cobb WS, Kercher KW, Heniford BT (2005) Laparoscopic repair of incisional hernias. Surg Clin North Am 85(1):91–103
Luijendijk RW, Hop WC, van den Tol MP, de Lange DC, Braaksma MM, JN IJ, Boelhouwer RU, de Vries BC, Salu MK, Wereldsma JC, Bruijninckx CM, Jeekel J (2000) A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med 343(6):392–398
Heniford BT, Park A, Ramshaw BJ, Voeller G (2003) Laparoscopic repair of ventral hernias: nine years’ experience with 850 consecutive hernias. Ann Surg 238(3):391–399, discussion 399–400
Fabian TC, Croce MA, Pritchard FE, Minard G, Hickerson WL, Howell RL, Schurr MJ, Kudsk KA (1994) Planned ventral hernia. Staged management for acute abdominal wall defects. Ann Surg 219(6):643–650, discussion 651–653
Jernigan TW, Fabian TC, Croce MA, Moore N, Pritchard FE, Minard G, Bee TK (2003) Staged management of giant abdominal wall defects: acute and long-term results. Ann Surg 238(3):349–355, discussion 355–357
van Geffen HJ, Simmermacher RK, van Vroonhoven TJ, van der Werken C (2005) Surgical treatment of large contaminated abdominal wall defects. J Am Coll Surg 201(2):206–212
Ramirez OM, Ruas E, Dellon AL (1990) “Components separation” method for closure of abdominal-wall defects: an anatomic and clinical study. Plast Reconstr Surg 86(3):519–526
Shestak KC, Edington HJ, and Johnson RR (2000) The separation of anatomic components technique for the reconstruction of massive midline abdominal wall defects: anatomy, surgical technique, applications, and limitations revisited. Plast Reconstr Surg 105(2):731–738, quiz 739
DiBello JN Jr, Moore JH Jr (1996) Sliding myofascial flap of the rectus abdominus muscles for the closure of recurrent ventral hernias. Plast Reconstr Surg 98(3):464–469
de Vries Reilingh TS, van Goor H, Rosman C, Bemelmans MH, de Jong D, van Nieuwenhoven EJ, van Engeland MI, Bleichrodt RP (2003) “Components separation technique” for the repair of large abdominal wall hernias. J Am Coll Surg 196(1):32–37
Birolini C, Utiyama EM, Rodrigues AJ Jr, Birolini D (2000) Elective colonic operation and prosthetic repair of incisional hernia: does contamination contraindicate abdominal wall prosthesis use? J Am Coll Surg 191(4):366–372
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Alaedeen, D.I., Lipman, J., Medalie, D. et al. The single-staged approach to the surgical management of abdominal wall hernias in contaminated fields. Hernia 11, 41–45 (2007). https://doi.org/10.1007/s10029-006-0164-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10029-006-0164-5