The Routine Use of Prosthetic Mesh in Austere Environments: Dogma versus Data

Abstract Background Mesh repair has become the standard in adult hernia repairs. Mesh infection is an uncommon but potentially devastating complication. Currently there is widespread dogma against the use of prosthetic mesh (PM) in deployed or austere environments, but little available data to support or refute this bias. Methods Retrospective review of all hernia repairs over 1 year in a forward deployed surgical unit in Afghanistan. Demographics, hernia type, repair performed and mesh type were evaluated. Follow up was completed up to 6 weeks and then as needed for up to a year, and complications to include infection were recorded. Results 66 patients were identified, mean age was 38 (range 3-80) and 98% were male. Single-dose perioperative antibiotics and standard sterile technique were utilized in all cases. The majority (70%) had PM placed. The mean operative time was 54 minutes and mean estimated blood loss was less than 25cc.The vast majority of our hernias were inguinal (95%) with one ventral and two umbilical hernias. In the PM group, there were no surgical site infections, no mesh infections, and no mesh explantation or reoperation. There were no recurrences in either group identified at up to 1-year postop. There was no statistically significant difference in any outcome measure between the PM and no-PM groups. Conclusions The use of prosthetic mesh for hernia repairs in the austere or forward environment appears safe and did not increase the risk of SSI, mesh infections, or recurrence.