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Chrüterei Stein Gruppe

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Asa Mesh 21 Cf PATCHED


Asa Mesh 21 Cf PATCHED

Emergency repair of complicated abdominal wall hernias may be associated with worsen outcome and a significant rate of postoperative complications. There is no consensus on management of complicated abdominal hernias. The main matter of debate is about the use of mesh in case of intestinal resection and the type of mesh to be used. Wound infection is the most common complication encountered and represents an immense burden especially in the presence of a mesh. The recurrence rate is an important topic that influences the final outcome. A World Society of Emergency Surgery (WSES) Consensus Conference was held in Bergamo in July 2013 with the aim to define recommendations for emergency repair of abdominal wall hernias in adults. This document represents the executive summary of the consensus conference approved by a WSES expert panel. In 2016, the guidelines have been revised and updated according to the most recent available literature.

Bacteria inherently colonize all surgical wounds, but not all of these contaminations ultimately lead to infection. In most patients, infection does not occur because innate host defences are able to eliminate microbes at the surgical site. However, there is some evidence that the implantation of foreign materials, such as prosthetic mesh, may lead to a decreased threshold for infection [3].

Several studies show clear advantages of mesh use in elective cases, where infection is uncommon [7]. Mesh is easy to use, has low complication rates, and significantly reduces the rate of hernia recurrence. However, few studies have investigated the outcome of mesh use in an emergency setting, where there is often surgical field contamination due to bowel involvement [8, 9].

A computerized search was done by the bibliographer in different databanks (MEDLINE, Scopus, Embase), and citations were included for the period between January 2000 and December 2016 using the primary search strategy: hernia, groin, inguinal, femoral, crural, umbilical, epigastric, spigelian, ventral, incisional, incarcerated, strangulated, acute, emergency, repair, suture, mesh, direct, synthetic, polypropylene, prosthetic, biologic, SSI, wound infection, bowel resection, intestinal resection, complication, morbidity, recurrence, timing, laparoscopy combined with AND/OR. No search restrictions were imposed. The dates were selected to allow comprehensive published abstracts of clinical trials, consensus conference, comparative studies, congresses, guidelines, government publication, multicenter studies, systematic reviews, meta-analysis, large case series, original articles, and randomized controlled trials. Narrative review articles were also analysed to determine other possible studies. Recommendation guidelines are evaluated according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE), a hierarchical, evidence-based rubric [11, 12] summarized in Table 2.

Another retrospective study published in 2008 investigated the role of laparoscopy in the management of incarcerated (non-reducible) ventral hernias. The authors concluded that laparoscopic repair of ventral abdominal wall hernias could be safely performed with low subsequent complication rates, even in the event of an incarcerated hernia. Careful bowel reduction with adhesiolysis and mesh repair in an uncontaminated abdomen (without inadvertent enterotomy) using a 5-cm-mesh overlap was an important factor predictive of successful clinical outcome [31].

The use of mesh in clean surgical fields (CDC wound class I) is associated with lower recurrence rate, if compared to tissue repair, without an increase in the wound infection rate. Prosthetic repair with a synthetic mesh is recommended for patients with intestinal incarceration and no signs of intestinal strangulation or concurrent bowel resection (clean surgical field) (grade 1A recommendation).

For patients with intestinal incarceration and no signs of intestinal strang


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