© 2008 Surgeon 6; 5: 274-7 274 | the royal colleges of surgeons of edinburgh and ireland PROSTHETIC REPAIR OF INCISIONAL HERNIA COMBINED WITH ELECTIVE BOWEL OPERATION 3rd Department of Surgery University of Athens School of Medicine ‘Attikon’ University Hospital Athens, Greece Correspondence to: Evangelos P. Misiakos, University of Athens , 76 Aigeou Pelagous Street, Agia Paraskevi, Athens 15 341, Greece Tel: + 30 210 5326419 Fax: +30 210 5326420 email: misiakos@med.uoa.gr A. Machairas T. Liakakos P. Patapis C. Petropoulos D. Tsapralis E. P. Misiakos Background and aims: Incisional hernia repair with mesh is considered a clean operation and it is not recommended to be perfomed at the same time with a potentially contaminated operation. The aim of this study is to assess the short-term results of a group of patients who underwent a colon operation and simultaneous incisional hernia repair with an onlay polypropylene mesh technique. Patients and Methods: From November to June 2006, 19 patients underwent incisional hernia repair with polypropylene mesh, with simultaneous colonic operation. In 13 patients reestablishment of bowel continuity after a Hartmann procedure was done, whereas in four patients a loop colostomy was closed. Two patients underwent colectomy for cancer. Results: Post-operatively one patient had a seroma and two others had wound infections which required mesh removal. The mean follow-up was 70.15±48.40 months (range 3 to 142 months). During this period ve patients died, four from progression of malignancy and one from myocardial infarction. Three patients (15.78 %) developed recurrence, two patients with previous Hartmann’s operation for complicated diverticulitis and wound infection and the third patient due to inappropriate mesh xation with buttonhole hernia development. Conclusion: Prosthetic repair of incisional hernias can be safely performed simultaneously with a colonic operation, with an acceptable rate of infectious complications and recurrence. It is unjustiable to avoid the use of mesh in a potentially contaminated eld when an appropriate technique is used. keywords: incisional hernia, mesh, colon, surgery Surgeon, 1 October 2008, pp.274-7 INTRODUCTION Despite advancements in technique and the intro- duction of new materials, incisional hernia repair still remains a significant clinical problem for patients who have undergone elective abdominal operations. 1-4 Incisional hernias occur in 1% to 19% after primary surgery and seem to be increasing recently as more aged patients and more advanced stages of disease are being operated on. 5-9 he recurrence rate of inci- sional hernia after primary closure is high, ranging between 10% and 50% and has been reduced to 3% to 18% after the introduction of prosthetic materials (meshes) in hernia repair. 6,7,10-13 he main predisposing factors for incisional hernia development are the patient’s advanced age, obesity, malnutrition, immunosupression, reoperations, type of incision, surgical technique, quality of suture material, technical or accidental problems during the operation (accidental enter- otomy) and wound infection. 5,7,14 Wound infection original article is considered a major predisposing factor leading to incisional hernia development, and is estimated to occur from 12% in elective colorectal resection to 36% in emergency cases. 5,15,16,17,18 Wound infection and intra-abdominal sepsis predisposing to hernia development are common after emergency large bowel operations. At further operations, while these patients are operated on to correct an incisional hernia, they may need a simultaneous colonic resection, or re-establishment of bowel continuity and/or closure of colostomy. 18 his raises a dilemma for the patients: ‘Is it wise to perform a potentially contaminated operation simultaneously with an obligatorily clean one, such as incisional hernia repair with mesh?’ 18-20 he aim of the present study was to analyse our clinical experience in a group of patients having under- gone elective bowel operations and simultaneous prosthetic incisional hernia repair, trying to give an answer to this challenging clinical question.