title: The single-staged approach to the surgical management of abdominal wall hernias in contaminated fields.
abstract: BACKGROUND
  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/m(2) (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.
authors.affiliation: Department of Surgery, Division of General Surgery, University Hospitals of Cleveland, Case Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA. Michael.rosen@uhhs.com
authors.forename: D I
authors.initials: DI
authors.lastname: Alaedeen
authors.forename: J
authors.initials: J
authors.lastname: Lipman
authors.forename: D
authors.initials: D
authors.lastname: Medalie
authors.forename: M J
authors.initials: MJ
authors.lastname: Rosen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D013505:Digestive System Surgical Procedures; D019115:Fasciitis, Necrotizing / Q000150:complications / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000150:complications / Q000382:microbiology / Q000601:surgery*; D006801:Humans; D007412:Intestinal Fistula / Q000150:complications / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000150:complications / Q000601:surgery; D012189:Retrospective Studies; D013526:Surgical Mesh; D013536:Suture Techniques; D016896:Treatment Outcome