Two-stage intestinal and abdominal wall repair in one hospital stay

Abstract

<h4>Background</h4>The available evidence regarding the sequential performance of gastrointestinal tract restoration and abdominal wall reconstruction in two surgical stages during a single hospitalization is limited and is based primarily on case series. In this study, we present our experience with the aim of describing the outcomes obtained in the repair of complex abdominal wall defects and the restoration of intestinal continuity using a two-stage approach within the same hospital stay.<h4>Methods</h4>Case series of patients who underwent elective surgery for gastrointestinal tract restoration, followed by abdominal wall reconstruction in a second surgical stage during the same hospitalization. Medical records of procedures performed between 2018 and 2023 were reviewed. All interventions were carried out electively by a multidisciplinary team involving the abdominal wall surgery group and colorectal surgery.<h4>Results</h4>A total of 30 patients were included. Both surgical procedures were completed in 73% of cases, with a mean interval of 6.3 days between the two surgeries. In 26% of patients, it was not possible to complete both procedures; the most frequent causes were anastomotic leakage and surgical site infection, each occurring in 9% of cases. The mean length of hospital stay was 14 days. The most common complications were postoperative ileus, anastomotic leakage, intestinal perforation, and deep surgical site infection.<h4>Conclusion</h4>Although concomitant surgery is associated with a higher risk of complications particularly in the setting of complex hernias-in appropriately selected patients, sequential procedures performed during the same hospitalization can achieve favorable outcomes, especially in stoma reversal. The implementation of prehabilitation programs and the adoption of shared decision-making models are essential to optimize outcomes and reduce associated morbidity.