POLYPROPYLENE MESH CLOSURE AFTER EMERGENCY LAPAROTOMY - MORBIDITY ANDOUTCOME

Background. Alternative methods for abdominal wall closure may be nece ssary after emergency laparotomy. The purpose of this study was to det ermine the morbidity and outcome of emergency fascial closure with pol ypropylene mesh. Methods. A retrospective review was Performed of all patients undergoing emergency fascial closure with polypropylene mesh from January 1990 to March 1994. Results. Seventy patients were identi fied. Indications for mesh placement included visceral edema (40), inf ected/necrotic fascia (21), and planned reexploration (7). Enteric fis tulas developed in five patients (7.1%). When omentum was interposed B etween intestine and mesh, the incidence of fistula was significantly reduced (0 of 51 vs 5 of 19, p < 0.01). Forty-two patients (60%) survi ved with wound closure, accomplished by shin flaps in 19 (45%), shin g rafting in 11 (26%), and secondary healing in 6 (14%); The mesh was re moved in six patients (14%). Complications of mesh extrusion and herni a occurred less often after skin flap closure compared with shin graft ing or secondary healing (1 of 19 vs 9 of 17, p < 0.01). No mesh infec tion occurred. Conclusions. Polypropylene mesh placement is an effecti ve alternative for abdominal closure after emergency laparotomy, even when intraabdominal sepsis is present. Fistulas associated with its us e may be effectively eliminated by the interposition of omentum betwee n bowel and mesh. Wound closure with; full-thickness skin flaps is the preferred method for soft tissue coverage when mesh is used.