title: Staged laparoscopic ventral and incisional hernia repair when faced with enterotomy or suspicion of an enterotomy.
abstract: Enterotomy is a significant complication of laparoscopic ventral or incisional hernia repair (LVHR) and can be devastating if missed. Enterotomy occurs in 2.6% of patients undergoing LVHR and is missed 21.8% of the time. Controversy exists regarding the management of known or potential enterotomies. Approaches for managing recognized enterotomies during hernia repair are usually employed immediately; in a nonstaged fashion; and include laparoscopic enterotomy repair with immediate LVHR, laparotomy for repair of enterotomy with concomitant LVHR, or conversion to laparotomy for both enterotomy and hernia repair. The staged approach for managing recognized or potential enterotomies is less commonly employed and involves laparoscopic repair of enterotomy, admission, and delayed but definitive laparoscopic hernia repair in the same hospitalization. The presence of known or potential enterotomies during LVHR presents a difficult problem and may be a contraindication for immediate placement of prosthetic because of increased risks posed for abdominal infection, reoperation, prosthetic removal, hernia recurrence, and death. The staged approach--with a 2- to 5-day delay--represents a safe solution to this challenging problem. We present 4 cases managed via staged approach due to an enterotomy, risk factors, and suspicion for missed or delayed enterotomies augmented by a review of the literature.
authors: Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.
authors: Anselm J
authors: AJ
authors: Tintinu
authors: Wenceslaus
authors: W
authors: Asonganyi
authors: Patricia L
authors: PL
authors: Turner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology* / Q000601:surgery; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods*; D008297:Male; D008875:Middle Aged