title: Impact of pericardium bovine patch (Tutomesh(®)) on incisional hernia treatment in contaminated or potentially contaminated fields: retrospective comparative study.
abstract: OBJECTIVE
  This retrospective comparative study analyzes the outcome of patients affected by incisional hernia in potentially contaminated or contaminated field, treated by three operative techniques.
  
  
  METHODS
  152 patients (62 M:90 F; mean age 65 ± 14 years) underwent incisional hernia repair (January 2002-January 2012) in complicated settings. Criteria of inclusion in the study were represented by the following causes of admission: mesh rejection/infection, obstruction without gangrene but with possible peritoneal bacterial translocation, obstruction with gangrene, enterocutaneous fistula or simultaneous presence of ileo- or colostomy. The patients were divided into three groups: A (n = 76), treated with primary closure technique; B and C (n = 38 each), with reinforcement by synthetic or pericardium bovine mesh (Tutomesh(®)), respectively. The prosthetic groups were divided into Onlay and Sublay subgroups.
  
  
  RESULTS
  Significant decreases in C vs A were observed for wound infection (3 vs 37%) and recurrence (0 vs 14%), and in C vs B for wound infection (3 vs 53%), seroma (0 vs 34%) and recurrence (0 vs 16%). Patients with concomitant bowel resection (BR) (43%) showed (all P < 0.05) an increase of overall morbidity (55 vs 33%) and wound infection rate (42 vs 24%) compared to cases without BR. Morbidity presented no significant differences in C-Onlay or Sublay subgroups. B-Sublay subgroup has (all P < 0.05) lower overall morbidity (20 vs 75%), wound infection (10 vs 68%) and seroma (0 vs 46%) than B-Onlay.
  
  
  CONCLUSIONS
  The pericardium bovine patch seems to be safe and effective to successfully repair ventral hernia in potentially contaminated operative fields, especially in association with bowel resection.
authors.affiliation: Unit of Endocrine, Digestive, and Emergency Surgery, Department of Biomedical Sciences and Human Oncology, University Medical School,"Aldo Moro" of Bari, Policlinico, P.zza G. Cesare,11, 70124, Bari, Italy, angelagurrado@libero.it.
authors.forename: A
authors.initials: A
authors.lastname: Gurrado
authors.forename: I F
authors.initials: IF
authors.lastname: Franco
authors.forename: G
authors.initials: G
authors.lastname: Lissidini
authors.forename: G
authors.initials: G
authors.lastname: Greco
authors.forename: M
authors.initials: M
authors.lastname: De Fazio
authors.forename: A
authors.initials: A
authors.lastname: Pasculli
authors.forename: A
authors.initials: A
authors.lastname: Girardi
authors.forename: G
authors.initials: G
authors.lastname: Piccinni
authors.forename: V
authors.initials: V
authors.lastname: Memeo
authors.forename: M
authors.initials: M
authors.lastname: Testini
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D001672:Biocompatible Materials / Q000008:administration & dosage; D002417:Cattle; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene / Q000008:administration & dosage; D012189:Retrospective Studies; D013526:Surgical Mesh / Q000009:adverse effects; D013530:Surgical Wound Infection / Q000601:surgery*; D058106:Wound Closure Techniques; D014945:Wound Healing; D055815:Young Adult
chemical_list: D001672:Biocompatible Materials; C000597419:Tutoplast; D011138:Polytetrafluoroethylene