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Enterotomy Outcomes in Abdominal Wall Reconstruction.

Samantha W Kerr1, Victoria L Walker2, Lucy R Hinton3

  • 1Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina.

The Journal of Surgical Research
|April 5, 2026
PubMed
Summary

Enterotomy (bowel injury) during abdominal wall reconstruction (AWR) is uncommon but increases wound complications and hernia recurrence. Careful surgical technique and managing wound issues are key for durable AWR outcomes.

Keywords:
Abdominal wall reconstructionEnterotomyHerniaMesh infectionWound infection

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Area of Science:

  • Abdominal Wall Reconstruction
  • Surgical Outcomes
  • Hernia Repair

Background:

  • Complex incisional hernias present significant surgical challenges.
  • Enterotomy (ENT), or bowel injury, is an infrequent but possible complication during abdominal wall reconstruction (AWR), especially in reoperative cases.
  • Limited data exist on the incidence and outcomes of ENT in AWR.

Purpose of the Study:

  • To investigate the incidence and outcomes of operative enterotomy (small bowel injury) during elective abdominal wall reconstruction.
  • To compare outcomes between patients who sustained an enterotomy and those who did not.
  • To identify factors influencing recurrence-free survival after AWR with or without enterotomy.

Main Methods:

  • A prospective database from a tertiary hernia center was queried for elective AWR procedures.
  • Patients undergoing operative enterotomy (ENT group) were compared to those without enterotomy (non-ENT group).
  • Statistical analyses, including Kaplan-Meier analysis for recurrence-free survival, were performed.

Main Results:

  • Enterotomy occurred in 1.5% of 2687 AWR patients.
  • The ENT group had higher rates of recurrent hernias (68.3% vs. 51.5%), longer operative times, increased length of stay, and more wound complications (36.6% vs. 19.5%).
  • Biologic mesh was used more in the ENT group, associated with lower wound complications compared to synthetic mesh, though recurrence rates were similar.

Conclusions:

  • Enterotomy during AWR is rare but significantly associated with increased wound morbidity and hernia recurrence.
  • Preventing bowel injury during AWR is crucial.
  • Aggressive management of wound complications is essential for the long-term success of abdominal wall reconstruction.