If a dedonitive meah is required I would go for biological. You could just use a vicryl to start with for augmentation. A prolene woild be unwise I think. Preferably no mesh, I agree with Ossama.
Because of the risk of bacterial contamination I would opt either for a biological mesh like Permacol or for an absorbable mesh like Vicryl (with intra operative antibiotic cover). There are no papers springing to mind comparing the two, however biological mesh seems to be favoured and there is a current trial comparing suture vs biological mesh closure.
Reoperations for ileostomy/colostomy clousure for the development of a ventral hernia at the site of clousue, is high. Because the infection of the clousure site is rare, I have no fear to use any type of mesh, so if the clousure can be performed without any (at all) tension, I rather no use mesh but if I have to do it I rather use a biological one.
The hernia rate after closure of an ostomy is reportedly 30%. This calls for a cognisant approach. I invite You to attend the first scientific meeting on hernia prevention next week in Barcelona, where the science will be discussed. I believe that vicryl meshes do not prevent herniation and there is also evidence that at least non-croslinked biomeshes do not prevent hernia in the long term. The most secure option in terms of hernia prevention is a modern synthetic mesh primary prophylaxis and evidence of safety also in terms of infectuous complications is rapidly emerging. Hope to see You.
In my opinion, a ventral hernia of 5 cm in diameter is an indication for mesh repair. For more than 20 years we have repared incisional hernias without biologic meshes with good results in term of recurrences or infections, placing prolene meshes in propeperitoneal positions. It seems not a big problem to repair an icisional hernia of 5 cm in diameter irrespective of the presence of an ileostomy or not.
In my opinion the ideal treatment for this patient is a ventral retromuscular hernioplasty (Rives-Soppa technique) with a large pore, lightweight polypropylene mesh. One advantage of this approach is that it allows prevention of a stoma site hernia. Moreover the statement that a permanent synthetic mesh cannot be used in clean-contaminated and contaminated fields seems to be no longer valid. Many reports showing no complications when using a permanent mesh in some elective contaminated settings including elective colorectal procedure and concomitant hernia mesh repair Very similar positive results have been found when using a mesh in both the prevention and treatment of parastomal hernias.
We have recently completed a study in which we used biological mesh and in other group by prolene suture herniorapphy. Results are bether with biological mesh.1 yr follow up no recurrence in biological mesh group. No infection in biological mesh group.
I prefer separating the ventral reconstruction and stoma closure sessions.
if available "Straits" is a good option as it is a biological mesh. The risk of infection is minimal although the cost is sometimes inhibitory. Polypropylene mesh can also be used with good results, although the reluctance is due to the infective complications.
I think the better way in this pathologies is separating the two rencostruction, stoma closure and abdomninal wall reconstruction separately. The polipropilene mesh, in our experience, is very good material, and only after failure polipropilene we used biological mesh
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