OC-034 SHORT- AND LONG-TERM OUTCOMES OF TEMPORISING ABDOMINAL CLOSURE WITH VICRYL MESH IN CONTAMINATED AND INFECTED FIELDS

Abstract Aim Abdominal wall reconstruction (AWR) in contaminated fields is associated with surgical site morbidity > 50% and high hernia recurrence rates. Patients undergoing surgery for intestinal failure are anatomically complex with fistulae+/-stomas within failed abdominal walls. Temporising the abdominal wall using vicryl mesh is an alternative to AWR. It avoids some of the morbidity of AWR however concern exists regarding persistent abdominal wall herniation longer-term. This study reports outcomes following temporising abdominal closure in contaminated fields. Methods Retrospective single-centre, observational study of all patients undergoing intestinal failure surgery in whom temporising abdominal closure was performed (2010–2019). Closure was achieved using 4-layers of vicryl mesh placed as an inlay, secured circumferentially using continuous absorbable suture. Results 26 patients were included (VHWG Grade 3:n=23, VHWG 4:n=3). Indication for surgery was enterocutaneous fistulation (N=18), continuity restoration(n=6) and explantation of infected mesh(n=2). 15 had laparostomy wounds and 8 had surgical site herniation. Median length of post-operative stay=31 days (range 11–161). Clavien Dindo>3 occurred in 9 cases (34%). Surgical site occurrences complicated 5/26 (20%) cases with zero 90-day mortalities. Median follow-up=25 months (range 4–118);6 patients were lost to follow-up (including 5 deaths from unrelated causes). There were zero fistula recurrences. 13/20 (65%) of patients developed notable persistent abdominal wall herniation however just 5 (25%) reported symptoms. Conclusions Temporising vicryl mesh closure is a simple method associated with low surgical site morbidity in contaminated fields. Despite persistent herniation re-fistulation rates are low and the majority of patients are free of abdominal wall morbidity at follow up.