Risks of subsequent abdominal operations after laparoscopic ventral hernia repair

Surg Endosc. 2017 Feb;31(2):823-828. doi: 10.1007/s00464-016-5038-z. Epub 2016 Jun 23.


Introduction: 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.

Methods: 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.

Results: A total of 733 patients underwent LVHR. The average age was 56.5 years, BMI 33.9 kg/m2, hernia size 115 cm2 (range 1-660 cm2), and mesh size 411 cm2 (range 17.7-1360 cm2). After a mean follow-up of 19.4 months, the overall hernia recurrence rate was 8.4 %. Subsequent abdominal operations were performed in 17 % (125 patients) at a mean 2.2 years. 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 %.

Conclusion: 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.

Keywords: Adhesions; Bowel resection; Complications; Enterotomy; Incisional hernia; Intraperitoneal; Laparoscopic; Mesh; Mesh infection; Outcomes; Surgical site infection; Ventral hernia.

MeSH terms

  • Adult
  • Aged
  • Bariatric Surgery*
  • Biliary Tract Diseases / surgery
  • Databases, Factual
  • Device Removal
  • Digestive System Surgical Procedures*
  • Female
  • Gynecologic Surgical Procedures*
  • Hernia, Ventral / surgery*
  • Herniorrhaphy*
  • Humans
  • Incisional Hernia / surgery*
  • Intestinal Obstruction / surgery
  • Laparoscopy*
  • Liver Diseases / surgery
  • Male
  • Middle Aged
  • Pancreatic Diseases / surgery
  • Prosthesis-Related Infections / surgery
  • Recurrence
  • Reoperation / statistics & numerical data*
  • Retrospective Studies
  • Risk
  • Surgical Mesh*