Polypropylene mesh repair of incarcerated and strangulated hernias: a prospective clinical study
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ORIGINAL ARTICLE
Polypropylene mesh repair of incarcerated and strangulated hernias: a prospective clinical study O. Topcu • A. Kurt • S. Soylu • G. Akgol M. Atabey • B. C. Karakus • C. Aydin
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Received: 26 October 2011 / Accepted: 30 July 2012 Ó Springer Japan 2012
Abstract Purpose There is a common doubt regarding the application of polypropylene mesh to treat incarcerated and strangulated hernias due to the possibility of surgical site infection. We aimed to investigate the results of mesh repair of incarcerated and strangulated hernias, and to evaluate the incidence of wound infection and recurrence. Methods One hundred and fifty-three consecutive patients with incarcerated and strangulated hernias underwent surgery with mesh repair. The patients were divided into two groups: a resection group and a nonresection group. Fisher’s exact test, the Chi-square test and independent samples t test were used to determine the statistical significance level (p \ 0.05).
Results While 53 patients required organ resection, the remaining 100 patients did not. The most frequently incarcerated organs were the omentum (86), small bowel (74) and colon (15). Most of the resections were performed in the omentum (36), small bowel (23) and colon (2). While five of the 53 patients (9.4 %) in the resection group developed wound infections, no infections were observed in the nonresection group (p = 0.004). The infection rate in all patients was 3.3 % (five of 153 patients). None of the infected patients required mesh removal. There were no mortalities or recurrence in either group. Conclusions The findings revealed effective and safe usage of mesh along with antibiotic therapy in patients undergoing incarcerated and strangulated hernia repair. Keywords Incarceration Strangulation Hernia Polypropylene mesh Infection
O. Topcu (&) A. Kurt G. Akgol M. Atabey B. C. Karakus C. Aydin Department of General Surgery, Faculty of Medicine, Cumhuriyet University, Sivas 58140, Turkey e-mail: [email protected] A. Kurt e-mail: [email protected] G. Akgol e-mail: [email protected] M. Atabey e-mail: [email protected] B. C. Karakus e-mail: [email protected] C. Aydin e-mail: [email protected] S. Soylu Department of General Surgery, Numune Hospital, Sivas 58140, Turkey e-mail: [email protected]
Introduction Incarcerated hernias require urgent surgical intervention regardless of the localization, and are a common clinical entity in daily surgical practice. Tension-free repair with prosthetic materials is a well-known procedure that has been proven safe for use in elective hernia surgery. Only a small number of previous studies have dealt with the use of prosthetic materials in emergency hernia repair [1–4]. Furthermore, classical surgical teaching contraindicates the use of prosthetic materials in the setting of incarceration due to the fear of infection [5, 6]. On the other hand, the consequences of wound infection in the presence of grafts may be more difficult to treat than those of classical repairs
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