A 60-year-old man with cirrhosis and ascites develops a large direct inguinal hernia. He is being evaluated for repair. According to current evidence, which statement regarding mesh use in contaminated or potentially contaminated fields is correct?

• A Synthetic mesh should never be used and biologic mesh is preferred
• B Synthetic mesh can be safely used in all contaminated fields
• C Mesh repair is absolutely contraindicated in patients with ascites
• D Biologic mesh or primary suture repair is preferred in contaminated fields ✓

Explanation

In contaminated or potentially contaminated surgical fields (strangulated bowel, peritonitis), synthetic mesh carries a high infection risk. Biologic mesh (acellular dermal matrix) or primary suture repair without mesh is preferred, though biologic mesh has higher recurrence rates. In patients with ascites, hernia repair can be performed with careful perioperative ascites control, and mesh may be used if the field is clean.

Reference: Schwartz's Principles of Surgery, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.