Mesh Sutured Repairs of Abdominal Wall Defects

Abstract

A new closure technique is introduced, which uses strips of macroporous polypropylene mesh as a suture for closure of abdominal wall defects due to failures of standard sutures and difficulties with planar meshes.

Methods: Strips of macroporous polypropylene mesh of 2 cm width were passed through the abdominal wall and tied as simple interrupted sutures. The surgical technique and surgical outcomes are presented.

Results: One hundred and seven patients underwent a mesh sutured abdominal wall closure. Seventy-six patients had preoperative hernias, and the mean hernia width by CT scan for those with scans was 9.1 cm. Forty-nine surgical fields were clean-contaminated, contaminated, or dirty. Five patients had infections within the first 30 days. Only one knot was removed as an office procedure. Mean follow-up at 234 days revealed 4 recurrent hernias.

Conclusions: Mesh sutured repairs reliably appose tissue under tension using concepts of force distribution and resistance to suture pull-through. The technique reduces the amount of foreign material required in comparison to sheet meshes, and avoids the shortcomings of monofilament sutures. Mesh sutured closures seem to be tolerant of bacterial contamination with low hernia recurrence rates and have replaced our routine use of mesh sheets and bioprosthetic grafts.

Figures

Fig. 1.

Artist’s drawing of mesh sutured closure of the abdominal wall.

Fig. 2.

Multiple recurrent enterocutaneous fistula patient with scarred skin and abdominal wall. CT scan shows a bowel obstruction and separation of the rectus muscles of 6 cm. The patient had already undergone an anterior components release.

Fig. 3.

Complex abdominal wound after bowel repair.

Fig. 4.

Closure of abdominal defect using interrupted strips of polypropylene mesh that are tied as simple sutures.

Fig. 5.

A, Immediate postoperative result. Mesh strips left exposed in a central area due to an inability to close the skin due to prior scarring. B, Four-month result at the time of diverting ostomy takedown showing closure of soft tissues over mesh sutured repair with local wound care.

Video Graphic 1.

See video, Supplemental Digital Content, a sharp hemostat is used to pierce the abdominal wall approximately 1 cm from the newly debrided edge of the rectus muscle. The mesh strip is then pulled through the substance of the abdominal wall and then tied like a suture with 3 throws to close the defect, http://links.lww.com/PRSGO/A265.

Fig. 6.

Large skin grafted abdominal wall hernia with end colostomy.

Fig. 7.

Abdomen after end colostomy takedown and placement of diverting ileostomy.

Fig. 8.

Closure of abdominal wall hernia with mesh strips. A components release was not required in this compliant abdominal wall.

Fig. 9.

Closed abdominal wall with mesh strips.

Fig. 10.

Three-month postoperative result showing closed abdominal defect and diverting ileostomy.

Fig. 11.

Spontaneous small-bowel lymphoma-induced enterocutaneous fistula emerging through 9-cm hernia defect in a patient with a prior ileal conduit.

Fig. 12.

Image after resection and repair of enterocutaneous fistula. Due to chronically inflamed and infected tissues, a polyglactin mesh was placed for 2 days to obtain wound control.

Fig. 13.

After polyglactin mesh removal and bilateral components releases with perforator preservation, mesh sutures were placed across the abdominal defect. The wound was relatively clean, with one pocket of purulence that was debrided.

Fig. 14.

Closure of 9-cm hernia defect with mesh sutured technique.

Fig. 15.

Early postoperative result demonstrating primary healing.