Gas gangrene of the abdominal wall due to late-onset enteric fistula after polyester mesh repair of an incisional hernia

Department A of General Surgery, Charles Nicole Hospital, Tunis, Tunisia.
Hernia (Impact Factor: 2.05). 10/2010; 16(2):215-7. DOI: 10.1007/s10029-010-0734-4
Source: PubMed


The occurrence of enteric fistulae after wall repair using a prosthetic mesh is a serious but, fortunately, rare complication. We report the case of a 66-year-old diabetic man who presented with gas gangrene of the abdominal wall due to an intra-abdominal abscess caused by intestinal erosion six years after an incisional hernia repair using a polyester mesh. The aim of this case report is to illustrate the seriousness of enteric fistula after parietal repair using a synthetic material.

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Available from: Sami Daldoul, Sep 11, 2014
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    • "While conventional biomaterials such as polypropylene or polyester achieve good abdominal repair both in terms of tissue and biomechanical behaviour, when placed in contact with the visceral peritoneum these materials can lead to complications such as tissue adhesions or abdominal obstruction [11], mesh migration to hollow organs [12], or to more serious complications such as intestinal fistula [13,14]. To avoid these adverse events, composites consist of two biomaterials one of which acts as a non-absorbable barrier [15]. "
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    ABSTRACT: Composite biomaterials designed for the repair of abdominal wall defects are composed of a mesh component and a laminar barrier in contact with the visceral peritoneum. This study assesses the behaviour of a new composite mesh by comparing it with two latest-generation composites currently used in clinical practice. Defects (7x5cm) created in the anterior abdominal wall of New Zealand White rabbits were repaired using a polypropylene mesh and the composites: Physiomesh(TM); Ventralight(TM) and a new composite mesh with a three-dimensional macroporous polyester structure and an oxidized collagen/chitosan barrier. Animals were sacrificed on days 14 and 90 postimplant. Specimens were processed to determine host tissue incorporation, gene/protein expression of neo-collagens (RT-PCR/immunofluorescence), macrophage response (RAM-11-immunolabelling) and biomechanical resistance. On postoperative days 7/14, each animal was examined laparoscopically to quantify adhesions between the visceral peritoneum and implant. The new composite mesh showed the lowest incidence of seroma in the short term. At each time point, the mesh surface covered with adhesions was greater in controls than composites. By day 14, the implants were fully infiltrated by a loose connective tissue that became denser over time. At 90 days, the peritoneal mesh surface was lined with a stable mesothelium. The new composite mesh induced more rapid tissue maturation than Physiomesh(TM), giving rise to a neoformed tissue containing more type I collagen. In Ventralight(TM) the macrophage reaction was intense and significantly greater than the other composites at both follow-up times. Tensile strengths were similar for each biomaterial. All composites showed optimal peritoneal behaviour, inducing good peritoneal regeneration and scarce postoperative adhesion formation. A greater foreign body reaction was observed for Ventralight(TM). All composites induced good collagen deposition accompanied by optimal tensile strength. The three-dimensional macroporous structure of the new composite mesh may promote rapid tissue regeneration within the mesh.
    Full-text · Article · Nov 2013 · PLoS ONE
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    ABSTRACT: Ventral hernia repairs are among the most common operations performed by general surgeons throughout the world. In the United States, ∼105,000 ventral abdominal hernias are repaired each year. Incisional hernias, most commonly resulting from a laparotomy, occur after 3–20 % of operations [1–3]. Factors predisposing patients to the formation of an initial ventral hernia include obesity, advanced age, diabetes, steroid use, pulmonary disease, and infectious wound complications. Surgical approaches to ventral hernia repair have been a subject of much research and debate for many years. Existing evidence strongly supports performing tension-free hernia repairs using prosthetic devices in most patients and all hernia sizes [4]. Recurrence rates below 20 % are the norm with the currently popular Rives/Stoppa/Wantz method of the prosthetic repair of a ventral hernia. The key principles of this operation are the use of a large prosthesis as an underlay, wide fascial overlap, and tension-free repair [5, 6]. The Achilles heel of this approach is the possibility of mesh infection and the frequent wound complications, ranging from 12 to 20 % [2]. The minimally invasive approach takes advantage of the wide exposure and accessibility for prosthetic placement while eliminating the large incision, extensive subcutaneous dissection and tissue flaps, the need for drains, and ultimately lowering the incidence of wound complications [7]. Since the first reports of a laparoscopic ventral hernia repair more than 15 years ago, large series as well as randomized studies have been published.
    No preview · Chapter · Jan 2013
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    ABSTRACT: Objective: This article analyzes radiopaque properties of meshes currently used in hernia surgery. A search was conducted using PubMed and a combination of the terms "hernia repair," "mesh," "laparoscopy," "CT," "MRI," "radiopaque," and "high-resolution techniques." Conclusion: The visibility of meshes varies from not visible at all (e.g., Ultrapro), to hardly discernible (Prolene), to readily seen (Composix), and finally to the always visible (Dualmesh). Radiopaque properties of meshes have been insufficiently recognized by both the manufacturers and clinicians.
    No preview · Article · Dec 2013 · American Journal of Roentgenology
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