title: Multi-staged repair of contaminated primary and recurrent giant incisional herniae in the same hospital admission: a proposal for a new approach.
abstract: BACKGROUND
  Repair of primary and recurrent giant incisional herniae is extremely challenging and more so in the face of surgical field contamination. Literature supports the single- and multi-staged approaches including the use of biological meshes for these difficult patients with their associated benefits and limitations.
  
  
  METHODS
  This is a retrospective analysis of a prospective study of five patients who were successfully treated through a multi-staged approach but in the same hospital admission, not previously described, for the repair of contaminated primary and recurrent giant incisional herniae in a district general hospital between 2009 and 2012. Patient demographics including their BMI and ASA, previous and current operative history including complications and follow-up were collected in a secure database. The first stage involved the eradication of contamination, and the second stage was the definitive hernia repair with the new generation-coated synthetic meshes.
  
  
  RESULTS
  Of the five patients, three were men and two women with a mean age of 58 (45-74) years. Two patients had grade 4 while the remaining had grade 3 hernia as per the hernia grading system with a mean BMI of 35 (30-46). All patients required extensive adhesiolysis, bowel resection and anastomoses and wash out. Hernial defect was measured as 204* (105-440) cm(2), size of mesh implant was 568* (375-930) cm(2) and the total duration of operation (1st + 2nd Stage) was 354* (270-540) min. Duration of hospital stay was 11* (7-19) days with a follow-up of 17* (6-36) months.
  
  
  CONCLUSIONS
  We believe that our multi-staged approach in the same hospital admission (for the repair of contaminated primary and recurrent giant incisional herniae), excludes the disadvantages of a true multi-staged approach and simultaneously minimises the risks and complications associated with a single-staged repair, can be adopted for these challenging patients for a successful outcome (* indicates mean).
authors: Department of Surgery, East Kent University Hospitals NHS Foundation Trust, Ashford, Kent, UK, sk.sid@hotmail.co.uk.
authors: K
authors: K
authors: Siddique
authors: A
authors: A
authors: Shrestha
authors: S
authors: S
authors: Basu
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D000368:Aged; D015992:Body Mass Index; D005260:Female; D046449:Hernia, Abdominal / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D013526:Surgical Mesh; D013530:Surgical Wound Infection / Q000601:surgery*; D007507:Therapeutic Irrigation