Late intestinal fistula associated with prosthetic repair of the abdominalwall.

Study aim: The aim of this retrospective study was to describe an unusual c omplication of the nonabsorbable meshes used for repair of incisional herni a or inguinal hernia. Patients and methods: This study included eight observations of intestinal fistulas that occured between 1 and 13 years after using Mersilene (Dacron) mesh for repair of an incisional hernia (7 cases) and an inguinal hernia ( 1 case). There were 6 men and 2 women (mean age: 58 years, range: 35-85 yea rs) with an external intestinal fistula (n=6) or an internal intestinal fis tula (n=2). All the patients required a reoperation for extraction of the m esh and treatment of the bowel injuries. Results: There was one secondary death in a 85 years old woman in relation with a vascular complication after incomplete excision of the prosthesis. I n five patients out of six, there was a recurrence of the incisional hernia . Conclusion: The intestinal fistulas associated with prosthetic repair of th e abdominal wall are mostly observed with intraperitoneal mesh but this fac tor is not exclusive. Their frequency after repair of incisional or inguina l hernia with non absorbable mesh is estimated between 0,3 and 35%. The use of nonabsorbable mesh should be limited to the indications of strict neces sity, without any septic context or emergency surgery. The contact of the m esh with the bowel should be formally avoided. (C) 2001 Editions scientifiq ues et medicales Elsevier SAS.