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Multi-staged repair of contaminated primary and recurrent giant incisional herniae in the same hospital admission: a proposal for a new approach

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Abstract

Background

Repair of primary and recurrent giant incisional herniae is extremely challenging and more so in the face of surgical field contamination. Literature supports the single- and multi-staged approaches including the use of biological meshes for these difficult patients with their associated benefits and limitations.

Patients and methods

This is a retrospective analysis of a prospective study of five patients who were successfully treated through a multi-staged approach but in the same hospital admission, not previously described, for the repair of contaminated primary and recurrent giant incisional herniae in a district general hospital between 2009 and 2012. Patient demographics including their BMI and ASA, previous and current operative history including complications and follow-up were collected in a secure database. The first stage involved the eradication of contamination, and the second stage was the definitive hernia repair with the new generation-coated synthetic meshes.

Results

Of the five patients, three were men and two women with a mean age of 58 (45–74) years. Two patients had grade 4 while the remaining had grade 3 hernia as per the hernia grading system with a mean BMI of 35 (30–46). All patients required extensive adhesiolysis, bowel resection and anastomoses and wash out. Hernial defect was measured as 204* (105–440) cm2, size of mesh implant was 568* (375–930) cm2 and the total duration of operation (1st + 2nd Stage) was 354* (270–540) min. Duration of hospital stay was 11* (7–19) days with a follow-up of 17* (6–36) months.

Conclusion

We believe that our multi-staged approach in the same hospital admission (for the repair of contaminated primary and recurrent giant incisional herniae), excludes the disadvantages of a true multi-staged approach and simultaneously minimises the risks and complications associated with a single-staged repair, can be adopted for these challenging patients for a successful outcome (* indicates mean).

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Notes

  1. * mean.

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Conflict of interest

All authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Surgery, East Kent University Hospitals NHS Foundation Trust, Ashford, Kent, UK

    K. Siddique, A. Shrestha & S. Basu

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  1. K. Siddique
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  2. A. Shrestha
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  3. S. Basu
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Correspondence to S. Basu.

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Siddique, K., Shrestha, A. & Basu, S. Multi-staged repair of contaminated primary and recurrent giant incisional herniae in the same hospital admission: a proposal for a new approach. Hernia 18, 57–63 (2014). https://doi.org/10.1007/s10029-013-1051-5

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  • DOI: https://doi.org/10.1007/s10029-013-1051-5

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