EP.TU.933Late enterocutaneous fistula formation after evisceration repair using intraperitoneal mesh. (28th October 2021)

• Record Type: Journal Article
• Authors: Rodicio, Jose; Sanz, Sandra; Vico, Tamara; Amoza, Sonia; Moreno, Maria; Sanz, Lourdes
• Is Part Of: British journal of surgery. Volume 108:Supplement 7(2021)
• Publication Date: 2021-10-28
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1093/bjs/znab311.114
• Languages: English
• ISSNs: 0007-1323

Abstract

Abstract: Introduction: Intraperitoneal meshes pose a potential risk of complications, either due to the material itself or the method of fixation. Enteric fistulas are a rare but serious complication following the repair of an abdominal wall reconstruction using an intraperitoneal prosthesis. Case report: We present a 59-year-old male patient, who underwent surgery 5 years previously for urothelial carcinoma with radical cystoprostatectomy and a Bricker-type urinary diversion, without subsequent radiotherapy. He presented an evisceration in the postoperative period treated with an inlay placement of an intraperitoneal mesh, without fascial closure. During these five years the wound did not present any complications, and spontaneous intestinal drainage began through the laparotomy. The physical exploration showed a 2cm hole in the abdominal infraumbilical midline, a wall defect of 20x20cm contained by mesh, no parastomal hernia, BMI 31.2 kg/m 2 . Thoraco-abdominal CT studies were completed that ruled out other pathologies, nasal culture and optimization were performed with parenteral nutrition and glycosylated hemoglobin control to achieve values below 6. The reconstruction of the abdominal wall was done with posterior component separation with transversus abdominis release, double mesh placement a BioA and PVDF mesh, with a final bridge measuring 8x5cm. The postoperative period was prolonged by an ileus, with an admission period of two weeks. Discussion: Intraperitoneal meshes, some of which are no longer commercially available, represent a potential risk of complication. As long as we can optimize the patient for surgery, we will improve the results. Retromuscular repair with large mesh and PVDF material gives us good results.