title: Implantation of prophylactic nonabsorbable intraperitoneal mesh in patients with peritonitis is safe and feasible.
abstract: BACKGROUND
  Patients with peritonitis undergoing emergency laparotomy are at increased risk for postoperative open abdomen and incisional hernia. This study aimed to evaluate the outcome of prophylactic intraperitoneal mesh implantation compared with conventional abdominal wall closure in patients with peritonitis undergoing emergency laparotomy.
  
  
  METHODS
  A matched case-control study was performed. To analyze a high-risk population for incisional hernia formation, only patients with at least two of the following risk factors were included: male sex, body mass index (BMI) >25 kg/m(2), malignant tumor, or previous abdominal incision. In 63 patients with peritonitis, a prophylactic nonabsorbable mesh was implanted intraperitoneally between 2005 and 2010. These patients were compared with 70 patients with the same risk factors and peritonitis undergoing emergency laparotomy over a 1-year period (2008) who underwent conventional abdominal closure without mesh implantation.
  
  
  RESULTS
  Demographic parameters, including sex, age, BMI, grade of intraabdominal infection, and operating time were comparable in the two groups. Incidence of surgical site infections (SSIs) was not different between groups (61.9 vs. 60.3 %; p = 0.603). Enterocutaneous fistula occurred in three patients in the mesh group (4.8 %) and in two patients in the control group (2.9 %; p = 0.667). The incidence of incisional hernia was significantly lower in the mesh group (2/63 patients) than in the control group (20/70 patients) (3.2 vs. 28.6 %; p < 0.001).
  
  
  CONCLUSIONS
  Prophylactic intraperitoneal mesh can be safely implanted in patients with peritonitis. It significantly reduces the incidence of incisional hernia. The incidences of SSI and enterocutaneous fistula formation were similar to those seen with conventional abdominal closure.
authors.affiliation: Department of Visceral Surgery and Medicine, Inselspital, University Hospital of Bern, University of Bern, 3010 Bern, Switzerland. anita.kurmann@insel.ch
authors.forename: Anita
authors.initials: A
authors.lastname: Kurmann
authors.forename: Corina
authors.initials: C
authors.lastname: Barnetta
authors.forename: Daniel
authors.initials: D
authors.lastname: Candinas
authors.forename: Guido
authors.initials: G
authors.lastname: Beldi
mesh_terms: D058107:Abdominal Wound Closure Techniques / Q000295:instrumentation*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D004630:Emergencies; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D012189:Retrospective Studies; D012307:Risk Factors; D013526:Surgical Mesh; D016896:Treatment Outcome