Hernia | 2021
Comment to: “Outcomes of concomitant mesh placement and intestinal procedures during open ventral hernia repair”
Abstract
We read with great interest the recent article by Moazzez A [1], published in Hernia. The authors reported the results of mesh placement and concomitant bowel resection, and concluded that mesh placement at the time of concomitant bowel procedure was associated with higher morbidity, SSIs, reoperations, and readmissions. We congratulate the authors for this important publication with large patient’s number and meaningful results, and their study would be an important contribution to this controversial issue, since mesh placement in such situation is always a hot issue and a dilemma from either the surgeons’ or patients’ side, even after thorough pre-operative and per-operative consulting. We completely agree with the authors’ conclusion, at the mean time, we felt the need to discuss a few points on this issue. First, the authors reported that increased surgical-site infections (SSI) were associated with concomitant intestinal procedure, however, it is important to know the characteristics of the exact bowel procedure, and which are closely correlated with the surgical field contamination degree, and are quite important for decision-making for mesh placement, these characteristics include the type of the involved bowels (small intestine or large bowels), the profile of bowel procedure (closure of small perforation or multiple segments of bowel resections), the presence or absence of pre-operative bowel preparation, emergency or elective bowel procedure, and all these aspects are important for decision-making prior to mesh placement. Therefore, although the overall results of concomitant bowel procedures were associated with an increased SSI rate, the stratification of these factors would be useful consideration prior to mesh placement. Second, it is important to differentiate two scenarios: (1) the SSI was caused by the additional tissue dissection procedure to accommodate the mesh, (2) the SSI was caused by the mesh itself. Since tissue dissection itself and component separation (if which was done) are the risk factors of SSI [2]. Therefore, to avoid the possibility of increased tissue dissection caused SSI in the presence of concomitant bowel procedure, the choice of less tissue dissection procedure is preferable. Third, the mesh placement layer and mesh types were absent in the present study, and which would definitely influence the incidence of surgical-site infection [3]. At last, we are eager to know the exact reasons for patient readmission and reoperation, the incidence of deep mesh infection, as well as the incidence of final mesh removal, since these results would provide paramount information for the further analysis of mesh placement with concomitant bowel procedure. Even though we comment a few points, we applaud for Moazzez et al. for their excellent work and their contributions to this controversial issue.