title: 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 56.5 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 %.
  
  
  
  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.
authors.affiliation: Division of Minimal Access and Bariatric Surgery, Greenville Health System, University of South Carolina School of Medicine - Greenville, 701 Grove Road, Greenville, SC, 29605, USA.
authors.forename: Puraj P
authors.initials: PP
authors.lastname: Patel
authors.affiliation: Division of Minimal Access and Bariatric Surgery, Greenville Health System, University of South Carolina School of Medicine - Greenville, 701 Grove Road, Greenville, SC, 29605, USA.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Love
authors.affiliation: Division of Minimal Access and Bariatric Surgery, Greenville Health System, University of South Carolina School of Medicine - Greenville, 701 Grove Road, Greenville, SC, 29605, USA.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Ewing
authors.affiliation: Division of Minimal Access and Bariatric Surgery, Greenville Health System, University of South Carolina School of Medicine - Greenville, 701 Grove Road, Greenville, SC, 29605, USA.
authors.forename: Jeremy A
authors.initials: JA
authors.lastname: Warren
authors.affiliation: Division of Minimal Access and Bariatric Surgery, Greenville Health System, University of South Carolina School of Medicine - Greenville, 701 Grove Road, Greenville, SC, 29605, USA.
authors.forename: William S
authors.initials: WS
authors.lastname: Cobb
authors.affiliation: Division of Minimal Access and Bariatric Surgery, Greenville Health System, University of South Carolina School of Medicine - Greenville, 701 Grove Road, Greenville, SC, 29605, USA. ACarbonell@ghs.org.
authors.forename: Alfredo M
authors.initials: AM
authors.lastname: Carbonell
mesh_terms: D000328:Adult; D000368:Aged; D050110:Bariatric Surgery; D001660:Biliary Tract Diseases / Q000601:surgery; D016208:Databases, Factual; D020878:Device Removal; D013505:Digestive System Surgical Procedures; D005260:Female; D013509:Gynecologic Surgical Procedures; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy; D006801:Humans; D000069290:Incisional Hernia / Q000601:surgery*; D007415:Intestinal Obstruction / Q000601:surgery; D010535:Laparoscopy; D008107:Liver Diseases / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000601:surgery; D016459:Prosthesis-Related Infections / Q000601:surgery; D012008:Recurrence; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012306:Risk; D013526:Surgical Mesh
keywords: Adhesions; Bowel resection; Complications; Enterotomy; Incisional hernia; Intraperitoneal; Laparoscopic; Mesh; Mesh infection; Outcomes; Surgical site infection; Ventral hernia