Use of a mesh for musculoaponeurotic defects of the abdominal wall in cancer surgery and the risk of bowel fistulas.

Enterocutaneous fistulas resulting from mesh reconstruction of full-thickness musculoaponeurotic abdominal defects in benign conditions is a relatively infrequent, but serious complication.In the period 1977 to 1986, 26 patients with abdominal wall defects due to ablative surgery for carcinoma had repair with prosthetic material without any special effort to interpose tissue between bowel loops and the mesh. In the period 1986 to 1992, 30 patients with similar defects had tissue interposition between the bowel loops and the mesh (four patients had a free peritoneal patch). In an experimental study, 11 rabbits had an abdominal wall defect repaired with mesh alone, and 14 other rabbits had the abdominal wall defect repaired with the mesh plus a free peritoneal patch sutured underneath.In the first group of patients, six (23 percent) of 26 had enterocutaneous fistulas develop, in the second group zero (zero percent) of 30 had a fistula develop (p = 0.007). In the experimental study, the first group (ten of 11 rabbits) had dense adhesions develop between bowel loops and the mesh. In the second group, none of the 14 rabbits had adhesions develop (p < 0.0001).In full-thickness abdominal wall defects, omentum, muscle flap, or a peritoneal patch sewn under a mesh prevent fistula formation.