XXXX mesh closure after emergency laparotomy: morbidity and outcome.

@entity1 @entity295 @entity39 @entity4 @entity7502 @entity281 @entity292 @entity547
BACKGROUND: Alternative methods for abdominal wall closure may be necessary after emergency laparotomy. The purpose of this study was to determine the morbidity and outcome of emergency fascial closure with @entity7502 mesh. METHODS: A retrospective review was performed of all @entity1 undergoing emergency fascial closure with @entity7502 mesh from January 1990 to March 1994. RESULTS: Seventy @entity1 were identified. Indications for mesh placement included @entity4 (40), @entity39 (21), and planned reexploration (7). Enteric fistulas developed in five @entity1 (7.1%). When omentum was interposed between intestine and mesh, the incidence of @entity292 was significantly reduced (0 of 51 vs 5 of 19, p < 0.01). Forty-two @entity1 (60%) survived with wound closure, accomplished by skin flaps in 19 (45%), skin grafting in 11 (26%), and secondary healing in 6 (14%). The mesh was removed in six @entity1 (14%). Complications of mesh extrusion and @entity547 occurred less often after skin flap closure compared with skin grafting or secondary healing (1 of 19 vs 9 of 17, p < 0.01). No @entity281 occurred. CONCLUSIONS: @entity7502 mesh placement is an effective alternative for abdominal closure after emergency laparotomy, even when @entity295 is present. Fistulas associated with its use may be effectively eliminated by the interposition of omentum between bowel and mesh. Wound closure with full-thickness skin flaps is the preferred method for soft tissue coverage when mesh is used.
