Risks of subsequent abdominal operations after laparoscopic ventral hernia repair.

Abstract

Laparoscopic ventral hernia repair (LVHR) with intraperitoneal mesh placement is well established; however, the fate of patients requiring future abdominal operations is not well understood. This study identifies the characteristics of LVHR patients undergoing reoperation and the sequelae of reoperation. A retrospective review of a prospectively maintained database at a hernia referral center identified patients who underwent LVHR between 2005 and 2014 and then underwent a subsequent abdominal operation. The outcomes of those reoperations were collected. Data are presented as a mean with ranges. A total of 733 patients underwent LVHR. The average age was 56.5years, BMI 33.9kg/m2, hernia size 115cm2 (range 1-660cm2), and mesh size 411cm2 (range 17.7-1360cm2). After a mean follow-up of 19.4months, the overall hernia recurrence rate was 8.4%. Subsequent abdominal operations were performed in 17% (125 patients) at a mean 2.2years. The most common indication for reoperation was recurrent hernia (33 patients, 26.4%), followed by bowel obstruction (18 patients, 14.4%), hepatopancreaticobiliary (17 patients, 13.6%) and infected mesh removal (15 patients, 12%), gynecologic (10 patients, 8%), colorectal (8 patients, 6.4%), bariatric (4 patients, 3%), trauma (1 patient, 0.8%), and other (19 patients, 15%). The overall incidence of enterotomy or unplanned bowel resection (EBR) at reoperation was 4%. This occurred exclusively in those reoperated for complete bowel obstruction, and the reason for EBR was mesh-bowel adhesions. No other indication for reoperation resulted in EBR. The incidence of secondary mesh infection after subsequent operation was 2.4%. In a large consecutive series of LVHR, the rate of abdominal reoperation was 17%. Generally, these reoperations can be performed safely. A reoperation for bowel obstruction, however, may carry an increased risk of EBR as a direct result of mesh-bowel adhesions. Secondary mesh infection after reoperation, although rare, may also occur. Surgeons should discuss with their patients the potential long-term implications of having an intraperitoneal mesh and how it may impact future abdominal surgery.