The use of mesh in acute hernia: frequency and outcome in 99 cases.
BACKGROUND
Incarceration of inguinal, umbilical and cicatricial hernias is a frequent problem. However, little is known about the relationship between the use of mesh and outcome after surgery. The goal of this study was to describe the relationship between the use of mesh in incarcerated hernia and the clinical outcome.


METHODS
Correspondence, operation reports and patient files between January 1995 and December 2005 of patients presented at one academic and one teaching hospital in Rotterdam were searched for the following keywords: incarceration, strangulation and hernia. The patient characteristics, clinical presentation, pre-operative findings and clinical course were scored and analysed.


RESULTS
A total of 203 patients could be identified: 76 inguinal, 52 umbilical, 39 incisional, 14 epigastric, 14 femoral, five trocar and three spigelian hernias. In the statistical analysis, epigastric, femoral, trocar and spigelian hernias were pooled, due to their small group sizes. One patient was excluded from the analysis because the hernia was not corrected during operation. In total, 99 hernias were repaired using mesh versus 103 primary suture repairs. Twenty-five wound infections were registered (12.3%). One mesh was removed during a reintervention for anastomotic leakage, although no signs of wound infection were present. Nine patients died, none of them due to wound-related problems [one cardiovascular, one ruptured aneurysm, two anastomotic leakage, two sepsis e causa incognita (e.c.i.), three pulmonary complications]. Univariate analysis showed that female patients (P = 0.007), adipose patients (P = 0.016), patients with an umbilical hernia (P = 0.01) and patients who underwent a bowel resection (P = 0.015) had a significantly higher rate of wound infections. The type of repair (e.g. primary suture or mesh), use of antibiotic prophylaxis, gender, ASA class and age showed no significant relation with post-operative wound infection. After logistic regression analysis, only bowel resection (P = 0.020) showed a significant relation with post-operative wound infection.


CONCLUSIONS
Wound infection rates are high after the correction of acute hernia, but clinical consequences are relatively low. Mesh correction of an acute hernia seems to be safe and should be considered in every incarcerated hernia.
Department of Surgery, 10M, Erasmus MC, University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
J
J
Nieuwenhuizen
G H
GH
van Ramshorst
J G
JG
ten Brinke
T
T
de Wit
E
E
van der Harst
W C J
WC
Hop
J
J
Jeekel
J F
JF
Lange
D000208:Acute Disease; D003082:Colectomy / Q000009:adverse effects; D003106:Colon / Q000098:blood supply* / Q000601:surgery; D004630:Emergencies; D005260:Female; D006547:Hernia / Q000150:complications; D059685:Herniorrhaphy; D006801:Humans; D007511:Ischemia / Q000209:etiology*; D016015:Logistic Models; D008297:Male; D050177:Overweight / Q000150:complications; D013526:Surgical Mesh / Q000009:adverse effects*; D013530:Surgical Wound Infection / Q000209:etiology*; D013537:Sutures / Q000009:adverse effects*
Cochrane Database Syst Rev. 2002;(4):CD002197
12519568
Hernia. 2001 Jun;5(2):105-6
11505646
Hernia. 2008 Oct;12(5):457-63
18459033
Surg Today. 2007;37(3):212-4
17342359
Ann Surg. 2004 Oct;240(4):578-83; discussion 583-5
15383785
Dis Colon Rectum. 2003 Aug;46(8):1118-23
12907910
World J Surg. 1997 Jan;21(1):62-5; discussion 66
8943179
Hernia. 2007 Apr;11(2):163-7
17273815
Langenbecks Arch Surg. 2010 Jun;395(5):563-8
18758807
J Am Coll Surg. 2000 Oct;191(4):366-72
11030241
Hernia. 2005 Oct;9(3):259-62
15891813
Br J Surg. 2001 Oct;88(10):1321-3
11578284
N Engl J Med. 2000 Aug 10;343(6):392-8
10933738
Hernia. 2008 Apr;12(2):185-8
18004500
Br J Surg. 2002 Mar;89(3):293-7
11872052
Urology. 2005 Oct;66(4):874-7
16230159
Eur J Surg. 2002;168(8-9):452-4
12549683
World J Surg. 2006 Nov;30(11):2065-70
17043942
Hernia. 2003 Mar;7(1):44-6
12612798