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Кстати, как называется головной убор у этого мусульиманиа ?
World J Surg (2013) 37:1656–1660
DOI 10.1007/s00268-013-2019-4
Implantation of Prophylactic Nonabsorbable Intraperitoneal
Mesh in Patients With Peritonitis Is Safe and Feasible
Anita Kurmann • Corina Barnetta •
Daniel Candinas • Guido Beldi
Published online: 9 April 2013
Socie?te? Internationale de Chirurgie 2013
Abstract
Background Patients with peritonitis undergoing emer-
gency laparotomy are at increased risk for postoperative
open abdomen and incisional hernia. This study aimed to
evaluate the outcome of prophylactic intraperitoneal mesh
implantation compared with conventional abdominal wall
closure in patients with peritonitis undergoing emergency
laparotomy.
Method A matched case-control study was performed. To
analyze a high-risk population for incisional hernia for-
mation, only patients with at least two of the following risk
factors were included: male sex, body mass index (BMI)
[25 kg/m
2
, malignant tumor, or previous abdominal
incision. In 63 patients with peritonitis, a prophylactic
nonabsorbable mesh was implanted intraperitoneally
between 2005 and 2010. These patients were compared
with 70 patients with the same risk factors and peritonitis
undergoing emergency laparotomy over a 1-year period
(2008) who underwent conventional abdominal closure
without mesh implantation.
Results Demographic parameters, including sex, age,
BMI, grade of intraabdominal infection, and operating time
were comparable in the two groups. Incidence of surgical
site infections (SSIs) was not different between groups
(61.9 vs. 60.3 %; p = 0.603). Enterocutaneous ?stula
occurred in three patients in the mesh group (4.8 %) and in
two patients in the control group (2.9 %; p = 0.667). The
incidence of incisional hernia was signi?cantly lower in the
mesh group (2/63 patients) than in the control group (20/70
patients) (3.2 vs. 28.6 %; p \ 0.001).
Conclusions Prophylactic intraperitoneal mesh can be
safely implanted in patients with peritonitis. It signi?cantly
reduces the incidence of incisional hernia. The incidences
of SSI and enterocutaneous ?stula formation were similar
to those seen with conventional abdominal closure.
Introduction
Patients undergoing emergency surgery for peritonitis are
at increased risk of abdominal wall-related complications.
The risk of incisional hernia in patients with peritonitis is
elevated, with an incidence of up to 54 %, compared with
an incidence of 11–26 % in the general surgical population
[1–3]. Furthermore, up to 24.1 % of patients with perito-
nitis undergoing emergency laparotomy may develop fas-
cial dehiscence [4].
Prophylactic mesh implantation has been shown to
reduce the incidence of incisional hernia in patients
undergoing vascular or bariatric procedures [5–7]. How-
ever, it remains unclear if nonabsorbable intraperitoneal
mesh implantation in an infected abdominal cavity is safe
because of the theoretical increased risk of chronic mesh
infection and enterocutaneous ?stula [8–10].
In a previous study, we demonstrated the feasibility and
safety of nonresorbable intraperitoneal mesh placement in
patients with postoperative fascial dehiscence or an open
abdomen [11]. The present study aimed to evaluate the
safety and feasibility of prophylactic intraperitoneal mesh
implantation compared with conventional abdominal wall
closure in patients with peritonitis undergoing emergency
laparotomy.
A. Kurmann C. Barnetta D. Candinas G. Beldi (&)
Department of Visceral Surgery and Medicine, Inselspital,
University Hospital of Bern, University of Bern, 3010 Bern,
Switzerland
e-mail: guido.beldi@insel.ch
A. Kurmann
e-mail: anita.kurmann@insel.ch
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World J Surg (2013) 37:1656–1660
DOI 10.1007/s00268-013-2019-4
