Enterotomy Outcomes in Abdominal Wall Reconstruction

Reconstruction of complex incisional hernias can be technically challenging. Enterotomy (ENT) is infrequent in most abdominal wall reconstruction (AWR) cases, yet in complex, reoperative fields, bowel injury can be difficult to avoid. Data describing the incidence and outcomes of ENT in these operations remain limited.

A prospective, tertiary hernia center database was queried for elective AWR. Outcomes following an operative ENT (small bowel) were compared with no ENT (non-ENT). Standard statistical analyses were performed. Kaplan-Meier analysis compared recurrence-free survival between groups.

Of 2687 patients, 41 (1.5%) patients sustained an ENT. ENT and non-ENT were similar in age, body mass index, and smoking status (all P > 0.05). Diabetes was more prevalent in non-ENT (9.8% versus 23.8%; P = 0.027). Though similar defect sizes (189.0 (133.0, 308.0) versus 160.0 (63.0, 286.0); P = 0.093), ENT had more recurrent hernias (68.3% versus 51.5%; P = 0.033). Most operations were performed open (95.1% versus 93.3%) with all mesh placed preperitoneal. Biologic mesh was used more frequently in ENT (68.3% versus 19.2%; P < 0.001). Fascial closure was achieved in most cases (100.0% versus 93.1%; P = 0.401). Delayed primary closure was performed more often in ENT (14.6% versus 5.9%; P = 0.021). ENT had longer operative times (227.0 (193.0, 284.0) versus 181.0 (138.0, 230.0) minutes; P < 0.001), length-of-stay (6.0 (5.0, 8.0) versus 5.0 (3.0, 6.0) days; P < 0.001), wound complications (36.6% versus 19.5%; P = 0.006) and hernia recurrence (12.2% versus 3.7%; P = 0.005). Mesh infection was not different (4.9% versus 1.3%; P = 0.108). ENT wound complications were significantly lower in biologic versus synthetic mesh (25.0% versus 61.5%; P = 0.024), but recurrence (7.1% versus 23.1%; P = 0.304) was similar. Both ENT mesh infections were in synthetic mesh. Average follow-up was similar (15.1 (2.7, 49.9) versus 11.3 (1.3, 51.3) months; P = 0.311).

ENT during AWR is rare but is associated with wound morbidity and hernia recurrence. Prevention of bowel injury and aggressive mitigation of wound morbidity are important to preserving long-term durability of AWR.