Email updates

Keep up to date with the latest news and content from Annals of Surgical Innovation and Research and BioMed Central.

Open Access Research article

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

Hasnain Zafar, Masooma Zaidi, Irfan Qadir* and Ayaz Ahmed Memon

Author Affiliations

General Surgery Department, Aga Khan University Hospital, Stadium Road Karachi, Pakistan

For all author emails, please log on.

Annals of Surgical Innovation and Research 2012, 6:1  doi:10.1186/1750-1164-6-1

Published: 4 January 2012

Abstract

Background

Emergency repair of incarcerated incisional hernia with associated bowel obstruction in potentially or contaminated field is technically challenging due to edematous, inflamed and friable tissues with occasional need for concurrent bowel resection and carries high rates of post-operative infectious complications. The aim of this study was to retrospectively assess the wound related morbidity of use of permanent prosthetic mesh in emergency repair of incarcerated incisional hernia with associated bowel obstruction. We also describe a new technique of leaving the mesh exposed to heal by secondary intention with granulation tissue.

Methods

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.

Results

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.

Conclusion

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.

Keywords:
Obstructed hernia; Incisional hernia; Emergency hernia repair