Marcel wrote:6. By separation of components, I mean take out all the prosthetic, make large
relaxing incisions in the anterior rectus sheaths bilaterally, pull the linea
alba together, and then irrigate and cover over the whole thing with a fresh
piece of polypropylene mesh. By now the bowel is protected by the patients own
tissue (rectus muscle and fascia) and the skin will usually be able to come
together and cover this.
I agree with all you said except this--and this is such a common practice
which represents the classic case of the doctor treating himself--there isn't
the slightest bit of evidence that covering a primarily-closed wound with a
prosthetic mesh has any benefit at all--are you really that insecure that you
feel you need to do something beyond your primary repair? I have chopped thru
enough of these abdominal walls with a layer of "security blanket" mesh
overlying a primary repair to know how horrendous a problem you thereby create
for the patient. I have also seen these closures dehisce and return with
ventral hernia despite the added mesh. Not only is this stuff expenseve (and
its so nice of you to add this useless cost to the patient's bill!), but it
can significantly increase the risk of complications--needlessly