Combined approach with negative pressure wound therapy and biological mesh for treatment of enterocutaneous fistula after synthetic mesh repair of incisional hernia. A case report

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Published: Apr 12, 2021
Keywords:
Biological prosthesis, owel mesh erosion, Enterocutaneous fistula, Negative Pressure Wound Therapy, pen incisional hernia repair

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Marino Di Furia
Department of Applied Clinical Sciences and Biotechnology, Section General Surgery, University of L’Aquila, L’Aquila, Italy
Andrea Della Penna
Department of Applied Clinical Sciences and Biotechnology, Section General Surgery, University of L’Aquila, L’Aquila, Italy
Ilaria Puccica
Department of Applied Clinical Sciences and Biotechnology, Section General Surgery, University of L’Aquila, L’Aquila, Italy
Derna Stifini
Department of Applied Clinical Sciences and Biotechnology, Section General Surgery, University of L’Aquila, L’Aquila, Italy
Andrea Salvatorelli
Department of Applied Clinical Sciences and Biotechnology, Section General Surgery, University of L’Aquila, L’Aquila, Italy
Federico Sista
Department of Applied Clinical Sciences and Biotechnology, Section General Surgery, University of L’Aquila, L’Aquila, Italy
Stefano Guadagni
Department of Applied Clinical Sciences and Biotechnology, Section General Surgery, University of L’Aquila, L’Aquila, Italy； Alma Mater Europea–European Center, Maribor, Slovenia
Marco Clementi
Department of Applied Clinical Sciences and Biotechnology, Section General Surgery, University of L’Aquila, L’Aquila, Italy

Abstract

AIM: Enterocutaneous fistula is a rare but severe complication of prosthetic incisional hernia repair. Management requires re-exploration with intestinal repair/resection and mesh removal. Repair of the parietal defect in this contaminated field is challenging.


MATERIAL OF STUDY: A 58-years male patient presented to our department one year after synthetic mesh repair of large incisional hernia with mesh infection and enterocutaneous fistula. The diagnosis was confirmed by ultrasound guided drainage and CT scans with oral contrast. A multiple-step surgical approach has been adopted: first, the mesh was removed, intestinal resection performed and posterior fascial closure obtained by bilateral transversus abdominis release (TAR) and supra-fascial NPWT (negative pressure wound therapy) was positioned and maintained for one week; second, a definitive repair was obtained by a biological prothesis fixed to posterior fascia and covered by anterior fascia closure. Then, new NPWT was positioned and maintained for 6 days on the skin closure. At 18-months follow-up, the patient showed no clinical or radiological signs of recurrence or reinfection.


DISCUSSION: Surgical strategies to face enterocutaneous fistula after prosthesis ventral hernia repair are not standardized.After bowel fistula treatment and mesh removal, the challenge of abdominal wall closure stay unsolved because of the high rate of complication and failure of a new prosthetic repair. A case-by-case management plan, often with the use of a multi-step strategy, may be an option.


CONCLUSION: This is a single recovery multiple-step strategy combined approach using NPWT and biological prothesis to manage a case of mesh infection by an enterocutaneous fistula. This unique approach has revealed safe and effective for the treatment of parietal defect in infected field resulting from a mesh removing procedure.

Article Details

How to Cite
Di Furia, Marino, et al. “Combined Approach With Negative Pressure Wound Therapy and Biological Mesh for Treatment of Enterocutaneous Fistula After Synthetic Mesh Repair of Incisional Hernia. A Case Report”. Annali Italiani Di Chirurgia, vol. 10, no. April, Apr. 2021, pp. 1-6, https://annaliitalianidichirurgia.it/index.php/aic/article/view/2052.
Issue
Vol. 10 No. April (2021)
Section
Case Report
Author Biographies

Marino Di Furia, Department of Applied Clinical Sciences and Biotechnology, Section General Surgery, University of L’Aquila, L’Aquila, Italy

 

 

 

Andrea Della Penna, Department of Applied Clinical Sciences and Biotechnology, Section General Surgery, University of L’Aquila, L’Aquila, Italy

 

 

 

Ilaria Puccica, Department of Applied Clinical Sciences and Biotechnology, Section General Surgery, University of L’Aquila, L’Aquila, Italy

 

 

 

Derna Stifini, Department of Applied Clinical Sciences and Biotechnology, Section General Surgery, University of L’Aquila, L’Aquila, Italy

 

 

 

Andrea Salvatorelli, Department of Applied Clinical Sciences and Biotechnology, Section General Surgery, University of L’Aquila, L’Aquila, Italy

 

 

 

Federico Sista, Department of Applied Clinical Sciences and Biotechnology, Section General Surgery, University of L’Aquila, L’Aquila, Italy

 

 

 

Stefano Guadagni, Department of Applied Clinical Sciences and Biotechnology, Section General Surgery, University of L’Aquila, L’Aquila, Italy； Alma Mater Europea–European Center, Maribor, Slovenia

 

 

 

Marco Clementi, Department of Applied Clinical Sciences and Biotechnology, Section General Surgery, University of L’Aquila, L’Aquila, Italy