Peer-reviewed veterinary case report
Outcomes of bowel injury during abdominal wall hernia repair
By Kerr SW et al.·2026·Department of Surgery·View original on Europe PMC →
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Original publication title: Enterotomy Outcomes in Abdominal Wall Reconstruction.
Plain-English summary
In a study of patients undergoing surgery to fix complex hernias, researchers looked at the outcomes of those who had a small bowel injury during the procedure compared to those who did not. Out of nearly 2,700 patients, only 41 experienced this type of injury. While both groups were similar in many ways, those with bowel injuries had a higher rate of hernia recurrence and more complications related to their wounds. The surgeries that involved bowel injuries took longer and required a longer hospital stay, but the type of mesh used for repairs also played a role in recovery. Overall, having a bowel injury during hernia repair is uncommon but can lead to more complications and a higher chance of the hernia coming back.
Abstract
<h4>Introduction</h4>Reconstruction of complex incisional hernias can be technically challenging. Enterotomy (ENT) is infrequent in most abdominal wall reconstruction (AWR) cases, yet in complex, reoperative fields, bowel injury can be difficult to avoid. Data describing the incidence and outcomes of ENT in these operations remain limited.<h4>Methods</h4>A prospective, tertiary hernia center database was queried for elective AWR. Outcomes following an operative ENT (small bowel) were compared with no ENT (non-ENT). Standard statistical analyses were performed. Kaplan-Meier analysis compared recurrence-free survival between groups.<h4>Results</h4>Of 2687 patients, 41 (1.5%) patients sustained an ENT. ENT and non-ENT were similar in age, body mass index, and smoking status (all P > 0.05). Diabetes was more prevalent in non-ENT (9.8% versus 23.8%; P = 0.027). Though similar defect sizes (189.0 (133.0, 308.0) versus 160.0 (63.0, 286.0); P = 0.093), ENT had more recurrent hernias (68.3% versus 51.5%; P = 0.033). Most operations were performed open (95.1% versus 93.3%) with all mesh placed preperitoneal. Biologic mesh was used more frequently in ENT (68.3% versus 19.2%; P < 0.001). Fascial closure was achieved in most cases (100.0% versus 93.1%; P = 0.401). Delayed primary closure was performed more often in ENT (14.6% versus 5.9%; P = 0.021). ENT had longer operative times (227.0 (193.0, 284.0) versus 181.0 (138.0, 230.0) minutes; P < 0.001), length-of-stay (6.0 (5.0, 8.0) versus 5.0 (3.0, 6.0) days; P < 0.001), wound complications (36.6% versus 19.5%; P = 0.006) and hernia recurrence (12.2% versus 3.7%; P = 0.005). Mesh infection was not different (4.9% versus 1.3%; P = 0.108). ENT wound complications were significantly lower in biologic versus synthetic mesh (25.0% versus 61.5%; P = 0.024), but recurrence (7.1% versus 23.1%; P = 0.304) was similar. Both ENT mesh infections were in synthetic mesh. Average follow-up was similar (15.1 (2.7, 49.9) versus 11.3 (1.3, 51.3) months; P = 0.311).<h4>Conclusions</h4>ENT during AWR is rare but is associated with wound morbidity and hernia recurrence. Prevention of bowel injury and aggressive mitigation of wound morbidity are important to preserving long-term durability of AWR.
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Search related cases →Original publication on Europe PMC: https://europepmc.org/article/MED/41936147