Elective colonic operation and prosthetic repair of incisional hernia: Does contamination contraindicate abdominal wall prosthesis use?

Background: Wound infection and sepsis leading to incisional hernia develop ment are common after emergency colonic operations. Later on, while being o perated on to correct an incisional hernia, most of these patients will nee d colonic resection or bowel continuity reestablishment. Simultaneous treat ment of incisional hernias in patients with colostomy or colonic disease re mains a difficult challenge, considering the reluctance of most surgeons to treat both conditions at the same time, especially when prosthetic repair is needed. Study Design: The aim of this study was to analyze the short-term results o f patients undergoing colonic resection or bowel continuity reestablishment and simultaneous incisional hernia repair with an onlay polypropylene mesh technique. Over a period of 6 years, 20 patients were operated on for colo nic problems associated with incisional hernias, including 8 Hartmanns' col ostomies, 6 colostomies or ileostomies with colonic mucous fistulas, 3 post operative colocutaneous fistulas, a paracolostomic hernia, a Chagas' megaco lon, and a pseudotumoral diverticulitis. A "rule of three" statistical anal ysis was used to estimate the maximum risk of adverse effects, concerning m esh-related morbidity, after 1- and 2-year followup. Results: A major complication occurred in a patient who developed an anasto motic leakage and secondary wound infection; the patient was treated with p arenteral nutrition and antibiotics. Other complications included a minor w ound infection, a seroma, and a chronic sinus. One patient died from postop erative problems unrelated to the surgical technique. The occurrence of pos toperative wound infection did not prevent mesh incorporation. Followup ran ging from 1 to 7 years detected no hernia recurrences; 13 patients were fol lowed for 2 years or more. Our results suggest that risk of mesh-related mo rbidity does not exceed 15.8% (3 of 19) within the first year and 23.1% (3 of 13) for 2 years followup, with 95% confidence. Conclusions: We concluded that prosthetic repair of incisional hernias asso ciated with simultaneous colonic operations was possible, allowing abdomina l wall anatomy reestablishment. There is no reason to believe that abdomina l wall prostheses must be avoided in contaminated operations when an adequa te surgical technique is used. (J Am Coll Surg 2000;191: 366-372. (C) 2000 by the American College of Surgeons).