{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T07:47:23Z","timestamp":1782373643238,"version":"3.54.5"},"reference-count":22,"publisher":"SAGE Publications","issue":"8","license":[{"start":{"date-parts":[[2026,2,22]],"date-time":"2026-02-22T00:00:00Z","timestamp":1771718400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Startup Fund for scientific research, Fujian Medical University","award":["Grant No. 2023QH1257"],"award-info":[{"award-number":["Grant No. 2023QH1257"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The American Surgeon\u2122"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Whether prosthetic mesh increases infection in contaminated fields remains controversial, particularly in incarcerated hernias and adult Bochdalek hernia (BH) with gastric pathology.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We combined a PRISMA-guided systematic review of adult BH with gastric pathology (14 cases, 1981-2025) with a single-center retrospective cohort of incarcerated hernias treated laparoscopically or laparoscopy-assisted (n = 313; inguinal 177, incisional 111, diaphragmatic 10 [4 BH, 1 Morgagni], and hiatal 15). Pure open repairs were excluded. Intraoperative findings were stratified as clean, mild, or severe contamination. Primary endpoint: 3-month infectious outcomes (surgical site infection, intra-abdominal abscess, and mesh infection) comparing mesh vs non-mesh repair. A representative BH case with gastric antral perforation managed by one-stage gastric repair and mesh-reinforced diaphragmatic closure is presented.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among clean cases receiving mesh, the 3-month infection rate was 1.5% (3\/198). In mild contamination, mesh did not increase infection compared with non-mesh repair (10.0% [4\/40] vs 6.7% [3\/45]; RR 1.50, 95% CI 0.36-6.30;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .702). In severe contamination, infection rates were also similar (21.4% [3\/14] vs 18.8% [3\/16]; RR 1.14, 95% CI 0.27-4.78;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 1.000). The BH review showed 57.1% gastric volvulus and 42.9% perforation\/necrosis; mesh was used selectively (21.4%) in staged or clean settings, and 37.5% of female cases occurred during pregnancy.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this laparoscopic-dominant cohort, mesh repair after meticulous lavage was not associated with higher 3-month infection across contamination strata and appeared safe in selected severely contaminated cases. These findings support a contamination-aware, selective mesh strategy within a CT-first, laparoscopy-first pathway and warrant prospective validation, particularly for open repairs and longer follow-up.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00031348251409256","type":"journal-article","created":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T06:39:11Z","timestamp":1771828751000},"page":"2139-2146","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Mesh Safety Under Contamination Across Incarcerated Hernias: A Single-Center Cohort Analysis With a Systematic Review of Adult Bochdalek Hernia Complicated by Gastric Pathologies"],"prefix":"10.1177","volume":"92","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-7568-0576","authenticated-orcid":false,"given":"Jie","family":"Gao","sequence":"first","affiliation":[{"name":"Nanping First Hospital Affiliated to Fujian Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mei","family":"Xu","sequence":"additional","affiliation":[{"name":"Nanping First Hospital Affiliated to Fujian Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Chen","sequence":"additional","affiliation":[{"name":"Nanping First Hospital Affiliated to Fujian Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiping","family":"Zheng","sequence":"additional","affiliation":[{"name":"Nanping First Hospital Affiliated to Fujian Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xing","family":"Huang","sequence":"additional","affiliation":[{"name":"Nanping First Hospital Affiliated to Fujian Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,2,22]]},"reference":[{"key":"e_1_3_6_2_2","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2024-261527"},{"issue":"5","key":"e_1_3_6_3_2","first-page":"987","article-title":"[complicated right bochdalek hernia]","volume":"84","author":"Suldrup F","year":"2024","unstructured":"Suldrup F, Espejo N, Higuera F, Wright F, Beskow A. [complicated right bochdalek hernia]. Medicina (Mex). 2024;84(5):987-991.","journal-title":"Medicina (Mex)"},{"key":"e_1_3_6_4_2","doi-asserted-by":"publisher","DOI":"10.1093\/jscr\/rjaf352"},{"key":"e_1_3_6_5_2","doi-asserted-by":"publisher","DOI":"10.1002\/ccr3.8502"},{"issue":"3","key":"e_1_3_6_6_2","first-page":"e56950","article-title":"Displacement of abdominal organs into the thoracic cavity: a rare case of adult bochdalek hernia","volume":"16","author":"Hu S","year":"2024","unstructured":"Hu S, Yang X, Wu Y. Displacement of abdominal organs into the thoracic cavity: a rare case of adult bochdalek hernia. Cureus. 2024;16(3):e56950.","journal-title":"Cureus"},{"key":"e_1_3_6_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000002197"},{"key":"e_1_3_6_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2021.08.046"},{"issue":"7","key":"e_1_3_6_9_2","first-page":"715","article-title":"[A case of Bochdalek hernia in an adult with volvulus of the stomach and hypopotassemia]","volume":"39","author":"Hiroumi Y","year":"1991","unstructured":"Hiroumi Y, Morita S, Simada T, et al. [A case of Bochdalek hernia in an adult with volvulus of the stomach and hypopotassemia]. Kokyu Junkan. 1991;39(7):715-719.","journal-title":"Kokyu Junkan"},{"key":"e_1_3_6_10_2","doi-asserted-by":"publisher","DOI":"10.14744\/tjtes.2022.62289"},{"issue":"10","key":"e_1_3_6_11_2","first-page":"877","article-title":"[Adult Bochdalek hernia with volvulus of the stomach]","volume":"61","author":"Ohtsuka H","year":"2008","unstructured":"Ohtsuka H, Kanzaki M, Imamura K, et al. [Adult Bochdalek hernia with volvulus of the stomach]. Kyobu Geka. 2008;61(10):877-880.","journal-title":"Kyobu Geka"},{"key":"e_1_3_6_12_2","doi-asserted-by":"publisher","DOI":"10.1111\/ases.12806"},{"key":"e_1_3_6_13_2","doi-asserted-by":"publisher","DOI":"10.7860\/JCDR\/2016\/18032.7552"},{"key":"e_1_3_6_14_2","doi-asserted-by":"publisher","DOI":"10.2147\/IJWH.S451513"},{"issue":"13","key":"e_1_3_6_15_2","first-page":"1143","article-title":"[Repair of a huge Bochdalek hernia by direct suture and mesh reconstruction]","volume":"67","author":"Sato H","year":"2014","unstructured":"Sato H, Yamashita K, Waki N, Kawai H, Ishizaki M, Nishi H. [Repair of a huge Bochdalek hernia by direct suture and mesh reconstruction]. Kyobu Geka. 2014;67(13):1143-1146.","journal-title":"Kyobu Geka"},{"key":"e_1_3_6_16_2","doi-asserted-by":"publisher","DOI":"10.1111\/ases.12309"},{"key":"e_1_3_6_17_2","doi-asserted-by":"publisher","DOI":"10.1097\/00129689-200206000-00009"},{"key":"e_1_3_6_18_2","doi-asserted-by":"publisher","DOI":"10.1007\/s004640040028"},{"issue":"3","key":"e_1_3_6_19_2","first-page":"247","article-title":"Hernie diaphragmatique embryonnaire (hernie de Bochdalek) bien tol\u00e9r\u00e9e jusqu'a 23 ans, compliqu\u00e9e d'\u00e9tranglement et de perforation au 7e mois d'une grossesse [Congenital diaphragmatic hernia (Bochdalek hernia) well tolerated up to twenty-three, then strangulated and perforated at the seventh month of pregnancy (author's transl)]","volume":"35","author":"Lampert M","year":"1981","unstructured":"Lampert M, Cinqualbre J, Tempe JD, Jaeger A, Forster E. Hernie diaphragmatique embryonnaire (hernie de Bochdalek) bien tol\u00e9r\u00e9e jusqu'a 23 ans, compliqu\u00e9e d'\u00e9tranglement et de perforation au 7e mois d'une grossesse [Congenital diaphragmatic hernia (Bochdalek hernia) well tolerated up to twenty-three, then strangulated and perforated at the seventh month of pregnancy (author's transl)]. Ann Chir. 1981;35(3):247-252.","journal-title":"Ann Chir"},{"issue":"1","key":"e_1_3_6_20_2","first-page":"e26","article-title":"Laparoscopic mesh repair of a Bochdalek diaphragmatic hernia with acute gastric volvulus in a pregnant patient","volume":"49","author":"Palanivelu C","year":"2008","unstructured":"Palanivelu C, Rangarajan M, Maheshkumaar GS, Parthasarathi R. Laparoscopic mesh repair of a Bochdalek diaphragmatic hernia with acute gastric volvulus in a pregnant patient. Singapore Med J. 2008;49(1):e26-e28.","journal-title":"Singapore Med J"},{"key":"e_1_3_6_21_2","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.170206"},{"key":"e_1_3_6_22_2","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.69917"},{"key":"e_1_3_6_23_2","doi-asserted-by":"publisher","DOI":"10.1007\/s004640042025"}],"container-title":["The American Surgeon\u2122"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00031348251409256","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/00031348251409256","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00031348251409256","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T07:00:08Z","timestamp":1782370808000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/00031348251409256"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,22]]},"references-count":22,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1177\/00031348251409256"],"URL":"https:\/\/doi.org\/10.1177\/00031348251409256","relation":{},"ISSN":["0003-1348","1555-9823"],"issn-type":[{"value":"0003-1348","type":"print"},{"value":"1555-9823","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,22]]}}}