Challenging the existent dogma - synthetic mesh placement in enterostomy closure

Abstract

Background & Aims : Enterostomy reversal and fascial defect cause weakness in the abdominal wall and may lead to formation of incisional hernia. Literature says that placement of synthetic mesh in dirty/contaminated wound causes high chances of surgical site infection (SSI) and mesh related complications. This dogma is now challenged. Present study was conducted to evaluate outcome of the placement of synthetic non-absorbable mesh after enterostomy closure in terms of SSI and incisional hernia. Materials & Methods: This prospective case-control study was conducted in the department of General surgery Netaji Subhash Chandra Bose (NSCB) medical college, Jabalpur, between 1 st December 2018 to 30 th September 2020. All patients of age >18 years with ileostomy/colostomy undergoing enterostomy reversal were included. Outcomes noted for wound infection/dehiscence, mesh related complications, its removal, and development of incisional hernia. Results: Total 60 patients were included in this study. Out of which, 30 (23 loop ileostomy, 5 double barrel ileostomy, and 2 colostomy) were taken as the case; where polypropylene mesh was placed (9 sublay and 21 onlay). 30 others (28 loop ileostomy, 1 double barrel ileostomy, and 1 colostomy) were taken as control where mesh was not placed after stoma closure. SSI was significantly lower in mesh placed group than non-mesh placed group (16.6% vs. 40%; P=0.019). Use of mesh was associated with slightly better outcomes but not significant in terms of rate of wound dehiscence (3.3% vs. 6.7%; Z=0.59; P=0.554) and incisional hernia (0 vs 6.7%; p= 0.492) in mesh and non-mesh groups, respectively. Mesh removal for chronic infection was not required in any case. Conclusion: Placement of permanent synthetic polypropylene mesh at the site of enter ostomy closure for prevention of incisional hernia can be done safely without fear of having increased risk of SSI and need of mesh removal.