Absorbable Polyglactin vs. Non-Cross-linked Porcine Biological Mesh for the Surgical Treatment of Infected Incisional Hernia.

BACKGROUND: The use of absorbable meshes during contaminated or infected incisional hernia (IH) repair is associated with high morbidity and recurrence rates. Biological meshes might be more appropriate but have been described in highly heterogeneous series. This study aimed at comparing the efficacy of absorbable vs. biological meshes for the treatment of contaminated or infected IH in a homogeneous series with a standardized technique. METHODS: Data of all patients operated on between 2008 and 2015 for contaminated or infected IH, using an absorbable (A) Vicryl® or a biological (B) Strattice® mesh, were reviewed. Patient characteristics, infectious complication rates, and recurrence-free outcome (RFO) were compared between the two groups. A propensity score methodology was applied to a Cox regression model to deal with unbalanced characteristics between groups. RESULTS: Patient demographics in A (n = 57) and in B (n = 24) were similar except that B patients had larger parietal defects (p < 0.001) and higher Center for Disease Control (CDC) wound class (p = 0.034). Patients in A had statistically significantly more postoperative early (61.4% vs. 33.3%, p = 0.03) and late (31.2% vs. 8.3%, p = 0.046) infectious complications. Six-, 12-, and 36-month RFO rates were 77%, 47%, and 24%, and 96%, 87%, and 82% in A and B, respectively, p < 0.001. Raw multivariable Cox regression analysis found that B (HR = 0.1, 95% CI [0.03-0.34], p < 0.001) was independently associated with prolonged RFO (HR = 0.091, 95% CI [0.045-0.180], p < 0.001). CONCLUSION: Biological meshes seem to be superior to absorbable meshes in patients with contaminated or infected incisional hernia. These results need to be confirmed by prospective randomized trials.

Morbimortalidad por infecciones posoperatorias en un servicio de Cirugía General / Morbidity and mortality due to postoperative infections in a General Surgery service

RESUMEN Fundamento: a pesar de los avances de las técnicas quirúrgicas, anestésicas y de la biotecnología, las infecciones posoperatorias es una complicación para el paciente operado, aumentan la morbimortalidad, y tienen repercusiones socioeconómicas desfavorables. Objetivo: determinar la incidencia de las infecciones posoperatorias y los posibles factores relacionados con su aparición. Métodos: se realizó un estudio observacional, descriptivo y transversal en 72 pacientes operados de cirugías mayores que presentaron infecciones posoperatorias en el servicio de Cirugía General del Hospital General Manuel Piti Fajardo de Florida, en el trienio 2015-2017, según variables seleccionadas. Resultados: la tasa de infecciones posquirúrgicas resultó inferior a lo esperado. Se infectaron más las operaciones sucias electivas. Las infecciones incisionales superficiales fueron las más frecuentes. La gran mayoría de las intervenciones demoraron menos de dos horas. El germen más aislado fue Staphylococcus aureus. La media de estadía hospitalaria se elevó de forma considerable y la tasa de mortalidad fue baja. Conclusiones: la tasa de infecciones posoperatorias en general se consideró aceptable y baja la mortalidad al compararlas con otros informes. El grado de contaminación y tipo de cirugía se relacionaron con la aparición de las infecciones. Debe insistirse en las medidas preventivas como profilaxis antimicrobiana y otras que deben comenzar en el preoperatorio, continuar durante la intervención y prolongarse en el posoperatorio, por las repercusiones socioeconómicas desfavorables de esta temible complicación.

ABSTRACT Background: despite advances in surgical, anesthetic and biotechnology techniques, postoperative infections continue to be a complication for the operated patient, increase morbidity and mortality, and have unfavorable socioeconomic repercussions. Objective: to determine the incidence of postoperative infections and the possible factors related to their appearance in the patients attended in our institution. Methods: an observational, descriptive and transversal study of 72 patients operated of major surgeries who presented postoperative infections in the General Surgery service of the General Hospital Manuel Piti Fajardo at Florida, in the 2015-2017 triennium, according to selected variables. Results: the postoperative infections rate was lower than expected. The dirty elective operations became more infected. The superficial incisional infections were the most frequent ones. The vast majority of interventions took less than two hours. The most isolated germ was Staphylococcus aureus. The average length of hospital stay increased considerably and the mortality rate was low. Conclusions: in general, the postoperative infections' rate was considered acceptable, and low mortality, compared to other reports. The degree of contamination and type of surgery were related to the appearance of infections. Emphasis should be placed on preventive measures such as antimicrobial prophylaxis and others that should be taken in the preoperative period, to continue during the intervention, and to be extended in the postoperative period, due to the unfavorable socioeconomic repercussions of this fearsome complication.