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Enterotomy During Hernia Repair: Prevention and Management

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Abstract

An inadvertent enterotomy during a laparoscopic or open ventral hernia repair is often unavoidable. If an enterotomy occurs it is associated with an increased risk of wound infections, mesh infections, enterocutaneous fistulas, and hernia recurrences. Multiple options exist for management of the ventral hernia in a clean-contaminated or contaminated wound; however, the management of the enterotomy takes priority. A missed enterotomy increases the mortality rate after ventral hernia repair so attentiveness is paramount throughout the entire procedure and in the postoperative recovery. Although certain factors associated with an increased risk of enterotomy during ventral hernia repair are identifiable preoperatively, all patients should be advised of the risk of enterotomy and instructed of the basic decision algorithm for management of an enterotomy during the informed consent process.

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References

  1. van der Krabben AA, Dijkstra FR, Nieuwenhuijzen M, et al. Morbidity and mortality of inadvertent enterotomy during adhesiolysis. Br J Surg. 2000;87:467–71.

    Article  Google Scholar 

  2. Igbal CW, Phar TH, Jospeh A, et al. Long-term outcome of 254 complex incisional hernia repairs using the modified Rives-Stoppa technique. World J Surg. 2007;31(12):2398–404.

    Article  Google Scholar 

  3. Salum M, Wexner SD, Nogueras JJ, et al. Does sodium hyaluronate- and carboxymethylcellulose-based bioresorbable membrane (Seprafilm) decrease operative time for loop ileostomy closure? Tech Coloproctol. 2006;10(3):187–91.

    Article  CAS  PubMed  Google Scholar 

  4. Kumar S, Wong PF, Leaper DJ. Intra-peritoneal prophylactic agents for preventing adhesions and adhesive intestinal obstruction after non-gynaecological abdominal surgery. Cochrane Database Syst Rev. 2009;21(1):1–34.

    Google Scholar 

  5. ten Broek RPG, van den Beukel BAW, vn Goor H. Comparison of operative notes with real-time observation of adhesiolysis-related complications during surgery. Br J Surg. 2013;100:426–32.

    Article  PubMed  Google Scholar 

  6. ten Broek R, Schreinemacher M, Jilesen A, et al. Enterotomy risk in abdominal wall repair: a prospective study. Ann Surg. 2012;256:280–7.

    Article  PubMed  Google Scholar 

  7. Gray SH, Vick CC, Graham LA, et al. Risk of complications from enterotomy or unplanned bowel resection during elective hernia repair. Arch Surg. 2008;143(6):582–6.

    Article  PubMed  Google Scholar 

  8. Halm JA, de Wall LL, Steyerberg EW, et al. Intraperitoneal polypropylene mesh hernia repair complicates subsequent abdominal surgery. World J Surg. 2007;31:423–9.

    Article  CAS  PubMed  Google Scholar 

  9. Huntington CR, Augenstein VA, Blair LJ et al. (2015) Inadvertent enterotomy: significant consequences for the open ventral hernia patient. Paper presented at the 1st world conference on abdominal wall hernia surgery, Milan, Italy, April 25–29, 2015.

    Google Scholar 

  10. Jenkins ED, Yom V, Melman L, et al. Prospective evaluation of adhesion characteristics to intraperitoneal mesh and adhesiolysis-related complications during laparoscopic re-exploration after prior ventral hernia repair. Surg Endosc. 2010;24(12):3002–7.

    Article  PubMed  Google Scholar 

  11. Adler AC, Adler SC, Livingston EH, et al. Current opinions about laparoscopic incisional hernia repair: a survey of practicing surgeons. Am J Surg. 2007;194(5):659–62.

    Article  Google Scholar 

  12. Heniford BT, Park A, Ramshaw BJ, et al. Laparoscopic repair of ventral hernias nine years’ experience with 850 consecutive hernias. Ann Surg. 2003;238:391–400.

    PubMed  PubMed Central  Google Scholar 

  13. Sharma A, Khullar R, Soni V, et al. Iatrogenic enterotomy in laparoscopic ventral/incisional hernia repair: a single center experience of 2,346 patients over 17 years. Hernia. 2013;17:581–7.

    Article  CAS  PubMed  Google Scholar 

  14. Awaiz A, Rahman F, Hossain MB, et al. Meta-analysis and systematic review of laparoscopic versus open mesh repair for elective incisional hernia. Hernia. 2015.

    Google Scholar 

  15. LeBlanc KA, Elieson MJ, Corder JM. Enterotomy and mortality rates of laparoscopic incisional and ventral hernia repair: a review of the literature. JSLS. 2007;11:408–14.

    PubMed  PubMed Central  Google Scholar 

  16. Earle D, Roth S, Saber A et al (2014) Guidelines for laparoscopic ventral hernia repair. http://www.sages.org/publications/guidelines/guidelines-for-laparoscopic-ventral-hernia-repair.

  17. Bittner R, Bingener-Casey J, Dietz U, et al. Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society [IEHS])—Part 2. Surg Endosc. 2014;28(2):353–79.

    Article  CAS  PubMed  Google Scholar 

  18. Tintinu AJ, Asonganyi W, Turner PL. Staged laparoscopic ventral and incisional hernia repair when faced with enterotomy or suspicion of an enterotomy. J Natl Med Assoc. 2012;104(3–4):202–10.

    Article  PubMed  Google Scholar 

  19. Lederman AB, Ramshaw BJ. A short-term delayed approach to laparoscopic ventral hernia when injury is suspected. Surg Innov. 2005;12(1):31–5.

    Article  PubMed  Google Scholar 

  20. Harth KC, Krpata DM, Chawla A, et al. Biologic mesh use practice patterns in abdominal wall reconstruction: a lack of consensus among surgeons. Hernia. 2013;17:13–20.

    Article  CAS  PubMed  Google Scholar 

  21. Itani KM, Rosen M, Vargo D, et al. Prospective study of single-stage repair of contaminated hernias using a biologic porcine tissue matrix: the RICH Study. Surgery. 2012;152(3):498–505.

    Article  PubMed  Google Scholar 

  22. Rosen MJ, Carbonell AM, Cobb WS et al. Multicenter, prospective, longitudinal trial evaluating recurrence, surgical site infection and quality of life after contaminated ventral hernia repair using biosynthetic absorbable mesh. Paper presented at the 1st world conference on abdominal wall hernia surgery, Milan, Italy, April 25–29, 2015.

    Google Scholar 

  23. Carbonell AM, Criss CN, Cobb WS, et al. Outcomes of synthetic mesh in contaminated ventral hernia repairs. J Am Coll Surg. 2013;217:991–8.

    Article  PubMed  Google Scholar 

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Correspondence to Brent D. Matthews M.D. .

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© 2016 Springer International Publishing Switzerland

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Matthews, B.D. (2016). Enterotomy During Hernia Repair: Prevention and Management. In: Novitsky, Y. (eds) Hernia Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-27470-6_35

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  • DOI: https://doi.org/10.1007/978-3-319-27470-6_35

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-27468-3

  • Online ISBN: 978-3-319-27470-6

  • eBook Packages: MedicineMedicine (R0)

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