Prosthetic repair, intestinal resection, and potentially contaminated areas: safe and feasible?
BACKGROUND
Prosthetic repair for abdominal wall hernia currently represents the gold standard. However, it is still difficult to identify the correct indication for prosthetic implant in borderline cases. The authors propose evaluating whether a prosthetic implant is absolutely contraindicated in potentially infected operating fields through the review of literature and personal experience.


METHODS
The authors performed ten prosthetic hernia repairs in potentially contaminated areas, with a preliminary preparation of the retromuscular-preperitoneal space hosting the prosthesis implant, and subsequent performance of the major operation.


RESULTS
There were neither major nor minor complications with a 21-month follow-up (mean period).


CONCLUSIONS
It is certain that both in noncomplicated inguinal hernia and in abdominal wall hernia repairs, the use of antibiotics can significantly reduce the number of infections. It is very important to underline that the success of the described procedure can be guaranteed only by an accurate preparation of the preperitoneal space: perfect haemostasis, temporary closure of the space with the insertion of iodine gauzes and suturing the edges, local antibiotic treatment, washing of the cavity, and accurate drainage.


CONCLUSIONS
Prosthetic repair is the gold standard for inguinal, incisional, and all abdominal wall hernias and should be used, with the method described, even in potentially contaminated areas. The use of a prosthesis has to be avoided in clearly infected cases.
Campanelli
G
G
Department of Surgical Sciences Pad. Beretta Est Ospedale Maggiore di Milano, University of Milano, Via F. Sforza 35, 20122, Milano, Italy. giampiero.campanelli@unimi.it
Nicolosi
F M
FM
Pettinari
D
D
Avesani
E Contessini
EC
D000009:Abdominal Muscles / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003082:Colectomy / Q000009:adverse effects / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007813:Laparotomy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013526:Surgical Mesh; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology