Dr Julia Jones is an unaccredited trainee at St Vincent’s Hospital, Sydney. She has an rock-climbing, snow skiing and the outdoors.
Prophylactic Mesh Repair In Colorectal Surgery: Preliminary Results
Incisional hernias are one of the most common long term complications of laparotomy with an incidence of 5-20% and cause a significant amount of morbidity following laparotomy as well as representing a considerable healthcare expense (Fischer, 2015). The use of prophylactic mesh in the prevention of incisional hernia following midline laparotomy has been shown to be safe when used in conjunction with vascular or bariatric surgery (Borab, 2017), however there remains perceived barriers to the use of prophylactic mesh during procedures involving bowel resection.
Aim We sought to compare the outcomes and complications associated with the use of prophylactic mesh in a cohort of colorectal patients undergoing midline laparotomy or reversal of ileostomy in conjunction with bowel resection.
Method All laparotomies on adults, involving resection of bowel over a 5 year period under the care of one general surgeon were included. Data regarding of age, comorbidities, emergency or elective operation, operative details, stoma formation, mesh insertion, post-operative complications, readmission and post-operative death were collated and analysed.
Results 389 bowel resections including 102 ileostomy reversals were performed over this period. Prophylactic on-lay mesh was inserted in 166 of these. The post-operative outcomes of wound infection, wound dehiscence, mesh removal, seroma formation, haematoma, enterocutaneous fistula, persistent post-operative pain, adhesional small bowel obstruction were not significantly different between the mesh & non-mesh groups and the mesh group demonstrated a substantially lower rate of incisional hernia formation.
Conclusion These results suggest that the aversion to using mesh following bowel resection may be unfounded and we plan to extend the dataset to the past 10 years based on these early results.