title: Intraperitoneal mesh implantation for fascial dehiscence and open abdomen.
abstract: BACKGROUND
  Postoperative fascial dehiscence and open abdomen are severe postoperative complications and are associated with surgical site infections, fistula, and hernia formation at long-term follow-up. This study was designed to investigate whether intraperitoneal implantation of a composite prosthetic mesh is feasible and safe.
  
  
  METHODS
  A total of 114 patients with postoperative fascial dehiscence and open abdomen who had undergone surgery between 2001 and 2009 were analyzed retrospectively. Contaminated (wound class 3) or dirty wounds (wound class 4) were present in all patients. A polypropylene-based composite mesh was implanted intraperitoneally in 51 patients, and in 63 patients the abdominal wall was closed without mesh implantation. The primary endpoint was incidence of incisional hernia, and the incidence of enterocutaneous fistula was a secondary endpoint.
  
  
  RESULTS
  The incidence of enterocutaneous fistulas after wound closure post-fascial dehiscence (13% vs. 6% without and with mesh, respectively) or post-open abdomen (22% vs. 28% without and with mesh, respectively) was not significantly different. The incidence of incisional hernia was significantly lower with mesh implantation compared with no-mesh implantation in both contaminated (4% vs. 28%; p = 0.025) and dirty abdominal cavities (5% vs. 34%; p = 0.01).
  
  
  CONCLUSIONS
  Intra-abdominal contamination is not a contraindication for intra-abdominal mesh implantation. The incidence of enterocutaneous fistula is not elevated despite the presence of contamination. The rate of incisional hernias is significantly reduced after intraperitoneal mesh implantation for postoperative fascial dehiscence or open abdomen.
authors.affiliation: Department of Visceral Surgery and Medicine, Bern University Hospital, University of Bern, 3010, Bern, Switzerland.
authors.forename: Moritz
authors.initials: M
authors.lastname: Scholtes
authors.forename: Anita
authors.initials: A
authors.lastname: Kurmann
authors.forename: Christian A
authors.initials: CA
authors.lastname: Seiler
authors.forename: Daniel
authors.initials: D
authors.lastname: Candinas
authors.forename: Guido
authors.initials: G
authors.lastname: Beldi
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000071938:Fasciotomy; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007412:Intestinal Fistula / Q000209:etiology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011126:Polypropylenes; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D013526:Surgical Mesh; D013529:Surgical Wound Dehiscence / Q000601:surgery*; D055815:Young Adult
chemical_list: D011126:Polypropylenes