Combined Ileostomy Closure and Abdominal Wall Hernia Repair

Introduction to Combined Procedure

Ileostomy closure and abdominal wall hernia repair can be safely performed together as a combined procedure in most patients, which reduces the need for multiple surgeries and decreases overall morbidity 1

The combined procedure is feasible when there is no active infection, inflammation, or intestinal strangulation requiring emergency intervention 2, 1

For midline abdominal wall hernia repair combined with ileostomy closure, use continuous suture technique for fascial closure as it is faster than interrupted sutures with no difference in hernia or dehiscence rates 3
For midline abdominal wall hernia repair combined with ileostomy closure, employ mass closure rather than layered closure for speed and equivalent outcomes 3
For midline abdominal wall hernia repair combined with ileostomy closure, maintain a suture-to-wound length ratio of at least 4:1 for continuous closure 3
For midline abdominal wall hernia repair combined with ileostomy closure, use small bite technique to prevent incisional hernia and wound complications 3
Synthetic mesh is recommended for hernia repair when there is no gross enteric spillage 1
Consider component separation technique for large midline abdominal wall hernias 4

For clean cases with no bowel ischemia, short-term prophylaxis is recommended 5
For cases with intestinal strangulation and/or concurrent bowel resection, 48-hour antimicrobial prophylaxis is recommended 5
Consider antimicrobial-coated sutures to reduce surgical site infection risk 3

Evaluate local tissue conditions, including absence of active infection at either site 1
Choose appropriate surgical technique, including combined procedure with synthetic mesh for small to moderate hernias with healthy tissue 1
Consider component separation with or without mesh reinforcement for large hernias 4

For clean surgical fields, the World Health Organization recommends synthetic mesh for hernia repair 6
For clean-contaminated fields, synthetic mesh can still be used safely, as recommended by the World Health Organization 7
For contaminated or dirty fields, primary repair for small defects or biological mesh for larger defects is recommended by the Centers for Disease Control and Prevention 8, 9
The American College of Surgeons suggests considering component separation technique for large midline abdominal wall hernias 10

Full antimicrobial therapy is required for cases with peritonitis, as recommended by the World Health Organization 6

When definitive fascial closure cannot be achieved, a skin-only closure is viable with subsequent repair of the eventration at a later stage, as suggested by the World Health Organization 9