Introduction: The repair of an abdominal wall defect in a contaminated field presents a difficult problem for the surgeon. While nonabsorbable prosthetic mesh may result in chronic infection, absorbable mesh results in inevitable recurrence. The use of a biological prosthetic mesh derived from porcine small intestine submucosa (Surgisis®) has been proposed as a solution to this difficult problem. We studied early outcomes following the use of Surgisis® mesh for abdominal wall defect closure in a contaminated field.
Methods: Consecutive patients undergoing Surgisis® repair of the abdominal wall in a contaminated field between February 2004 and May 2006 were identified from a prospective operating room database. Patients were examined for recurrent hernias and charts were reviewed. Outcomes included perioperative morbidity, hernia recurrence, mesh or wound infection, and reoperation.
Results: 19 patients were studied. The most frequent indications for the use of Surgisis® included abdominal wall closure following removal of infected mesh (7) and ventral hernia repair with bowel injury (6). Postoperative complications occurred in 18 patients (95%). Surgical site infections occurred in 16 patients (84%). Other complications included fistula in 5 (26%), seroma in 5 (26%), bowel obstruction in 3 (16%), ileus in 1 (5%), and hematoma in 1 (5%). There was one early reoperation to drain an abdominal wall abscess. With mean follow up of 12 months (range 3-22 months), incisional hernia was documented in 13/19 patients (68%). There were 21 meshes used in the 19 patients; at a cost of Can per mesh, this amounts to a mesh cost of Can per hernia prevented at 1 year.
Conclusions: Wound infection and postoperative hernia recurrence remain a significant problem when Surgisis® mesh is used in a contaminated field. Careful consideration should be given to the cost and benefit of this approach.