Surgical treatment of large contaminated abdominal wall defects.
BACKGROUND
Repair of a large, severely contaminated abdominal wall defect is a challenging problem. Most patients are currently treated with a multistaged procedure, which is time consuming, carries a high complication rate, and is often not finalized.


METHODS
In this study, our experience with a one-stage repair of contaminated abdominal wall defects using the Components Separation Method was evaluated with respect to morbidity and recurrence. Medical records of patients with contaminated abdominal wall defects, treated with the Components Separation Method from 1996 to 2000, were studied. Patients were invited to visit the outpatient clinic for a physical examination.


RESULTS
Twenty-six patients with a median age of 49 years and a mean defect size of 267 cm2 were treated. Intraoperative contamination, graded according to the National Research Council (NRC), showed 22 National Research Council III patients and 4 National Research Council IV patients. Postoperatively, five superficial wound infections, three cases of pneumonia, three instances of recurrent enterocutaneous fistulation, and two cases of sepsis were observed. One of the patients with sepsis died after anastomotic disruption led to peritonitis and multiple organ failure. Two asymptomatic recurrences were diagnosed (8%) after a median followup of 27 months.


CONCLUSIONS
Large contaminated abdominal wall hernias can be closed by the Components Separation Method, with a low recurrence rate but considerable morbidity.
van Geffen
Hendrikus J A A
HJ
Department of Surgery, University Medical Centre, Utrecht, The Netherlands.
Simmermacher
Roger K J
RK
van Vroonhoven
Theo J M V
TJ
van der Werken
Christiaan
C
D000328:Adult; D000368:Aged; D015984:Causality; D017577:Cutaneous Fistula / Q000209:etiology; D004210:Dissection / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D046449:Hernia, Abdominal / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007412:Intestinal Fistula / Q000209:etiology; D007813:Laparotomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology; D010538:Peritonitis / Q000209:etiology; D011014:Pneumonia / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology; D012008:Recurrence; D012086:Reoperation / Q000379:methods*; D018805:Sepsis / Q000209:etiology; D013526:Surgical Mesh; D013530:Surgical Wound Infection / Q000209:etiology / Q000601:surgery*; D013536:Suture Techniques; D013997:Time Factors; D016896:Treatment Outcome