Hernia repair in a potentially infected area : what should the surgeon do?

During the last century, surgeons have tried to improve hernia surgery results using prosthetic materials and antibiotic prophylaxis or therapy. However, despite new materials and new technology, hernia repair in potentially infected area remains still a problem. The case of a patient operated on, in the same time, for adenocarcinoma of the sigma plus 3 abdominal wall hernias is reported. The preperitoneal space in which the mesh was implanted to repair the abdominal hernias was opened, prepared, and temporarily closed suturing the peritoneum to the muscular fascia after inserting iodine gauze into this space before the sigma resection to avoid its contamination. Immediate post-operative period was free from any complications. At 4-year follow-up the patient is well and free from cancer and hernia recurrences. Therefore, it is suggested that prosthetic hernia repair associated with simultaneous abdominal operation is possible even in a potentially infected area allowing abdominal wall anatomy restablishment. We stress the need of an accurate surgical technique, and recommend antibiotic prophylaxis or therapy in all cases in order to reduce local septic complications.