title: Iatrogenic enterotomy in laparoscopic ventral/incisional hernia repair: a single center experience of 2,346 patients over 17 years.
abstract: OBJECTIVE
  Iatrogenic enterotomy (IE) during laparoscopic ventral/incisional hernia repair (LIVHR) is reported to be associated with poorer surgical outcomes. We report our experience with diagnosis, management and complications in patients who had IE during LIVHR at our tertiary referral institute between 1994 and 2011.
  
  
  METHODS
  We retrospectively reviewed prospectively collected data of 2,346 patients who underwent LIVHR from 1994 to 2011. We identified 33 patients who had IE during LIVHR. All surgical procedures were performed by five consultants and fellows under supervision who followed a standardized operative protocol. Patients were followed up for 6 months to evaluate morbidity, mortality, additional surgical procedures, unplanned readmissions and hospital stay.
  
  
  RESULTS
  Mortality occurred in 2 patients (6 %). Complications occurred in 16 patients (48.5 %). Median hospital stay was 3 days (2-36). Unplanned readmission was required in 6 patients (18 %). In 18 patients, (55 %) additional surgical procedures were required within 6 months of LIVHR. In 5 patients, the enterotomy was recognized postoperatively. These patients had worst outcomes [mortality 40 %, additional surgical procedures were required in all patients (100 %) and median hospital stay was 12 days (range 7-36)].
  
  
  CONCLUSIONS
  Iatrogenic enterotomy is a serious complication during LIVHR. IE is associated with mortality, morbidity, additional surgical procedures, unplanned readmissions and prolonged hospital stay. In patients where IE was recognized postoperatively, the prognosis was worst.
authors.affiliation: Max Institute of Minimal Access, Metabolic and Bariatric Surgery, Max Healthcare Institute Ltd., 1-2, Press Enclave Road, Saket, 110017, New Delhi, India, asharma736@yahoo.in.
authors.forename: A
authors.initials: A
authors.lastname: Sharma
authors.forename: R
authors.initials: R
authors.lastname: Khullar
authors.forename: V
authors.initials: V
authors.lastname: Soni
authors.forename: M
authors.initials: M
authors.lastname: Baijal
authors.forename: A
authors.initials: A
authors.lastname: Kapahi
authors.forename: K
authors.initials: K
authors.lastname: Najma
authors.forename: P K
authors.initials: PK
authors.lastname: Chowbey
mesh_terms: D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D007049:Iatrogenic Disease; D007194:India; D007422:Intestines / Q000293:injuries*; D007431:Intraoperative Complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009026:Mortality; D010359:Patient Readmission / Q000706:statistics & numerical data; D012086:Reoperation / Q000379:methods / Q000706:statistics & numerical data; D012421:Rupture / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D016896:Treatment Outcome