pp 1–17 | Cite as

The use of synthetic mesh in contaminated and infected abdominal wall repairs: challenging the dogma—A long-term prospective clinical trial

  • C. BiroliniEmail author
  • J. S. de Miranda
  • E. Y. Tanaka
  • E. M. Utiyama
  • S. Rasslan
  • D. Birolini
Original Article



Abdominal wall reconstruction in patients presenting with enteric fistulas and mesh infection is challenging. There is a consensus that synthetic mesh must be avoided in infected operations, and the alternatives to using synthetic mesh, such as component separation techniques and biologic mesh, present disappointing results with expressive wound infection and hernia recurrence rates.


A prospective clinical trial designed to evaluate the short- and long-term outcomes of 40 patients submitted to elective abdominal wall repair with synthetic mesh in the dirty-infected setting, and compared to a cohort of 40 patients submitted to clean ventral hernia repairs. Patients in both groups were submitted to a single-staged repair using onlay polypropylene mesh reinforcement.


Groups' characteristics were similar. There were 13 (32.5%) surgical site occurrences in the infected mesh (IM) group, compared to 11 (27.5%) in the clean-control (CC) group, p = 0.626. The 30-day surgical site infection rate was 15% for the IM group vs. 10% for the CC cases, p = 0.499. One patient required a complete mesh removal in each group. The mean overall follow-up was 50.2 ± 14.8 months, with 36 patients in the IM group and 38 clean-controls completing a follow-up of 36 months. There was one hernia recurrence (4.2%) in the IM group and no recurrences in the CC group.


We demonstrated that using polypropylene mesh in the infected setting presented similar outcomes to clean repairs. The use of synthetic mesh in the onlay position resulted in a safe and durable abdominal wall reconstruction.

Trial registration

Study registered at Plataforma Brasil (, CAAE 30836614.7.0000.0068. Study registered at Clinical Trials (, Identifier NCT03702153.


Hernia repair Mesh infection Enteric fistula Polypropylene Synthetic mesh Abdominal wall reconstruction 



No external funds or financial support were used for this study.

Compliance with ethical standards

Conflict of interest

None of the authors has conflicts of interests to declare.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Human and animal rights

This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  • C. Birolini
    • 1
    • 2
    Email author
  • J. S. de Miranda
    • 1
  • E. Y. Tanaka
    • 1
  • E. M. Utiyama
    • 1
  • S. Rasslan
    • 1
  • D. Birolini
    • 1
  1. 1.General and Trauma Surgery, Department of Surgery, School of MedicineUniversity of São PauloSão PauloBrazil
  2. 2.São PauloBrazil

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