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Enterotomy risk in abdominal wall repair: a prospective study.

Richard P G ten Broek¹, Marc H F Schreinemacher, Anneke P J Jilesen

¹Department of Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands. R.tenbroek@chir.umcn.nl

Annals of Surgery

|July 14, 2012

Summary

Enterotomy occurs in 1 in 8 patients during abdominal wall repair adhesiolysis. Prolonged adhesiolysis time is a key predictor of enterotomy, leading to increased postoperative complications and healthcare costs.

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Area of Science:

Abdominal surgery
Surgical complications
Hernia repair

Background:

Adhesions are common in abdominal wall repair, increasing surgical complexity.
Enterotomies during adhesiolysis significantly raise patient morbidity, particularly surgical site infections.
The incidence and impact of enterotomies and prolonged adhesiolysis in abdominal wall repair are not well understood.

Purpose of the Study:

To determine the incidence and predictors of enterotomy during abdominal wall repair adhesiolysis.
To evaluate the impact of enterotomies and extended adhesiolysis on postoperative morbidity and socioeconomic costs.

Main Methods:

A prospective cohort study of 133 patients undergoing elective abdominal wall repair from June 2008 to June 2010.
Surgical data, including adhesion characteristics, adhesiolysis time, and organ damage (enterotomies), were prospectively collected.

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Univariate and multivariate analyses identified predictive factors for enterotomy and assessed its impact on morbidity.

Main Results:

Adhesiolysis was needed in 93.2% of cases, with a mean duration of 35.7 minutes.
Enterotomy occurred in 12.8% of patients; prolonged adhesiolysis time (>30 minutes) was an independent predictor.
Enterotomy and extensive adhesiolysis were associated with increased urgent reoperations, parenteral feeding, wound infections, abdominal complications, and sepsis.

Conclusions:

Enterotomy complicates abdominal wall repair in approximately 1 in 8 patients.
Adhesiolysis duration is a significant predictor of inadvertent enterotomy.
Extensive adhesiolysis and enterotomies lead to substantial postoperative morbidity, prolonged hospitalization, and increased healthcare utilization.