Mesh repair for postoperative wound dehiscence in the presence of infection: is absorbable mesh safer than non-absorbable mesh?
OBJECTIVE
In patients with postoperative wound dehiscence in the presence of infection, extensive visceral oedema often necessitates mechanical containment of bowel. Prosthetic mesh is often used for this purpose. The aim of the present study was to assess the safety of the use of non-absorbable and absorbable meshes for this purpose.


METHODS
All patients that had undergone mesh repair of abdominal wound dehiscence between January 1988 and January 1998 in the presence of intra-abdominal infection were included in a retrospective cohort study. All surviving patients had physical follow-up in February 2001.


RESULTS
Eighteen patients were included in the study. Meshes consisted of polyglactin (n = 6), polypropylene (n = 8), polyester (n = 1), or a combination of a polypropylene mesh with a polyglactin mesh on the visceral side (n = 3). All patients developed complications, consisting mainly of mesh infection (77%), intra-abdominal abscess (17%), enterocutaneous fistula (17%), or mesh migration through the bowel (11%). Mesh removal was necessary in eight patients (44%). Within four months postoperatively, six patients (33%) had died because of progressive abdominal sepsis. The incidence of progressive abdominal sepsis was significantly higher in the group with absorbable polyglactin mesh than in the group with nonabsorbable mesh (67 vs. 11%, p = 0.02) After a mean follow-up of 49 months, 63% of the surviving patients had developed incisional hernia. Absorbable meshes did not yield better outcomes than nonabsorbable meshes in terms of complications and mortality rate.


CONCLUSIONS
Synthetic graft placement in the presence of intra-abdominal infection has a high risk of complications, regardless of whether absorbable (polyglactin) or non-absorbable mesh material (polypropylene or polyester) is used, and should be avoided if possible.
van't Riet
M
M
Department of Surgery, University Hospital Rotterdam, Dr Molewaterplein 40, 3015, GD Rotterdam, The Netherlands. mvantriet@hotmail.com
de Vos van Steenwijk
P J
PJ
Bonjer
H J
HJ
Steyerberg
E W
EW
Jeekel
J
J
D000005:Abdomen / Q000601:surgery; D020341:Absorbable Implants; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011098:Polyglactin 910; D011126:Polypropylenes; D012189:Retrospective Studies; D013526:Surgical Mesh; D013529:Surgical Wound Dehiscence / Q000209:etiology / Q000628:therapy*; D013530:Surgical Wound Infection / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome
D011126:Polypropylenes; D011098:Polyglactin 910