The Use of Prosthetic Mesh in the Emergency Management of Acute Incarcerated Inguinal Hernias

Introduction. Tension-free hernia repair has been regarded as a gold standard treatment for selected inguinal hernias, but the use of prosthetic mesh in acute incarcerated inguinal hernias is controversial. Our study focused on evaluating the safety and efficacy of the prosthetic mesh repair for emergency cases. Methods. Patients with acute incarcerated inguinal hernias who underwent emergency prosthetic mesh repair during 2009 to 2014 at our department were included. Patient characteristics, operative approaches and results, and complications were retrospectively analyzed. Results. A total of 167 patients were included in our study. One hundred and twenty-two patients underwent open surgery while the remaining 45 patients underwent transabdominal preperitoneal laparoscopic approach. The hernia was indirect inguinal in 133 patients (79.6%), direct inguinal in 15 patients (9.0%), and femoral in 19 patients (11.4%). The overall wound infection rate of these patients was 3%. Nonviable intestinal resection was performed in 25 patients (8.4%), only 2 of whom underwent wound infection. Another 3 patients who developed wound infection had viable hernia content. There was no mesh-related infection. There was no statistically significant difference in wound infection rates between patients with viable hernia contents and those with nonviable contents ( P < .05). Conclusion. The use of the prosthetic mesh in the treatment of acute incarcerated inguinal hernia is safe and effective. Nonviable intestinal resection cannot be regarded as a contradiction of the mesh repair.

Mesh repair versus mayo repair for paraumbilical hernia: a comparative study

Background: Para umbilical hernia is a multifactorial and complex process they are most commonly found along the midline linea Alba. This study aims to assess the efficacy of mesh repair in comparison to Mayo Repair and to analyze the morbidity associated with the management.Methods: The study was conducted in Victoria Hospital and Bowring and Lady Curzon Hospital attached to Bangalore Medical College & Research Institute, with clinical features suggestive of Paraumbilical Hernia (Minimum 30 cases each) from October 2010 to September 2012. Pediatric age group and those patients requiring emergency surgery have been excluded. 30 patients underwent Mayo’s repair and 30 patients underwent Mesh repair. Follow up period ranged from 2 months to 24 months.Results: paraumbilical hernia was found more commonly between 4rd and 6th decade of life with female: male 2.3:1. Most common presenting symptom was swelling with cough impulse (36.5%) and reducibility present. Commonest predisposing factors were multiparty and obesity. Percentage of early postoperative complications in Mayo’s repair was 13.6% and in Mesh repairs 6.6%. No statistical difference was noted. Percentage of recurrence following Mayo’s repair was 10% and following mesh repair was 0%. Postoperative complications like seroma, infections were similar in both procedures (Mayo’s repair and Mesh repair).Conclusions: Prosthetic mesh repair is a technique with good post-operative outcome, low recurrent rate and excellent patient satisfaction. It could become the gold standard in adult umbilical and paraumbilical hernia repair, in the future.

Prosthetic Mesh Repair in the Emergency Management of Acutely Strangulated Groin Hernias with Grade I Bowel Necrosis: A Rational Choice

The aim of this study was to determine the feasibility of prosthetic mesh repair according to the degree of bowel necrosis in the emergency management of acutely strangulated groin hernias. Emergency prosthetic mesh repair versus primary suture repair was randomly performed in 208 consecutive strangulated groin hernia patients with bowel necrosis between January 2005 and August 2016. The degree of bowel necrosis of each patient was determined according to a modified three-grade classification system. Patient characteristics sorted by repair method were analyzed by using Pearson's chi-squared tests. Correlations between mortality and wound-related morbidity with bowel necrosis grade and repair method were analyzed. There was no difference in gender, age, body mass index, comorbid diseases, hernia type (left or right, primary or recurrent), necrosis grade, and mortality between the mesh repair and suture repair groups (all P > 0.05). However, with regard to wound-related morbidity, there was significant difference between the two groups ( P < 0.05). Mortality and wound-related morbidity showed significant relationship with necrosis grade, especially with regard to postoperative wound infection ( P < 0.001). The wound infection rate with mesh repair was significantly higher than that with primary suture in Grade II and III necrosis patients ( P < 0.05), but there was no difference in Grade I patients ( P > 0.05). The use of prosthetic mesh in the emergency repair of acutely strangulated groin hernias seems to be as safe as suture-only repair in patients with noninfected strangulated bowel (Grade I necrosis). The use of prosthetic mesh repair is a rational choice made based on the degree of bowel necrosis in the emergency management of acutely strangulated hernias.