Is Prosthetic Repair of the Abdominal Wall in Clean-Contaminated Surgical Interventions Possible
D. Ion, R.V. Stoian, A. Bolocan, A. Cucu, M.B. Serban, D.N. PaduraruOriginal article, no. 6, 2013
The present study tries to provide an expressive, customizedanswer to the question in the title. The study relies on aten-year experience (2000-2009), evaluated retrospectively on agroup of 488 prosthetic repairs of incisional herniae, out ofwhich 432 were performed in a clean environment and 56 casesin a clean-contaminated one. The two groups are superimposable based on the Apache score. The visceral surgicalprocedures associated to the surgery of the parietal defect werevaried (cholecystectomy, appendectomy, enterectomy enterorrhaphy,colectomy colotomy-colorrhaphy, hysterectomy withadnexectomy). The assessment of postoperative suppurativecomplications showed no significant differences between thetwo groups (p 0.001). These results lead us to the idea ofdefining the indication for parietal prosthetic repair in acontaminated environment. The major factors of this decisionare: the nature, the source and the amount of the septicinoculum, the duration of exposure, the intensity of the hostinflammatory response (more difficult to quantify), and finallythe surgical judgment. The last mentioned factor will evaluatethe above-mentioned data and will take into account that notall bacterial contaminations are necessarily followed by anestablished infection. Thus, additional exaggerations - whichwould mean taking useless, ineffective precautions â€" as well asnegative exaggerations - which would mean hazardous boldness- will be avoided.
