Emergency incisional hernia repair: a difficult problem waiting for a solution

Between 2000 and 2010 a total of 60 patients underwent emergency surgery for incarcerated incisional hernia with associated bowel obstruction with placement of permanent prosthetic mesh. The wound was closed after hernia repair in 55 patients while it was left open to granulate in 5 patients.In the group of patients with primary wound closure, 11 patients developed superficial surgical site infection, 5 developed deep wound infection and one patient had cellulitis. These patients were treated with wound debridement and antibiotics. Mesh removal was required in one patient. There were no infections in the group of patients who had their surgical wounds left open. One patient in this group died on the fifth postoperative day from septicemia.Use of permanent prosthetic mesh in emergency repair of incarcerated incisional hernia with associated bowel obstruction. in contaminated field is associated with high risk of wound infection.Incisional hernias occur as a complication in up to 20% of abdominal surgeries [1]. Emergency repair of incarcerated incisional hernia with associated bowel obstruction. in contaminated field is technically challenging due to edematous, inflamed and friable tissues with occasional need for concurrent bowel resection and therefore high rates of post-operative infectious complications [2].A vast amount of literature advocates the use of prosthetic mesh in clean operative fields; in contrast utilization of prosthetic grafts in contaminated/obstructed settings has been seldom described [3]. Most surgeons believe that permanent prosthetic materials for incisional hernia repair are contraindicated in the setting of gross contamination, which includes emergency presentation of incarcerated incisional hernia with associated bowel obstruction as a subset, due to risk of infection as high as 10% to 35% [4]. However, primary repair of incisional hernia has high recurrence rates, ranging between 10% and 50%; while adoption of prosthesis lowers recurrence