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A Short-Term Delayed Approach to Laparoscopic Ventral Hernia When Injury Is Suspected

Western New England PC, Pittsfield, MA

Bruce J. Ramshaw, MD

Emory Hernia Institute, Emory University School of Medicine, Atlanta, GA; University of Missouri-Columbia, Columbia, MO; MC414 McHaney Hall, One Hospital Drive, Columbia, MO 65212 bramshaw98{at}yahoo.com

Laparoscopic repair is a safe and effective method for treating ventral hernias. Although the risk of bowel injury is low, its management is controversial. When injury is suspected or repaired, the risk of infection might prohibit a repair with prosthetic mesh. The timing of safe mesh placement is unclear. We retrospectively reviewed 9 patients from our prospective laparoscopic ventral hernia database who were treated with a 2-to 6-day delay in mesh placement due to violation of the gastrointestinal tract or risk of unidentified or delayed injury. All 9 patients had large ventral hernias from previous laparotomies (average defect, 399.4 cm2) and presented for elective repair. Three of the patients were morbidly obese, and one was diabetic. The decision to delay mesh placement was made intraoperatively. Reasons for delay were colotomy with repair, extensive serosal tears, resection after enterotomy, and resection for chronic small bowel obstruction. All patients received broad-spectrum antibiotics while awaiting definitive repair. In 7 patients, mesh was successfully placed between postoperative days 2 and 6. Delayed mesh placement failed in 2 patients due to loss of domain with bowel edema. The average length of stay was 9 days (range, 6 to 15 days) and average follow-up was 136 days (range, 36 to 303 days). No early mesh infections or other major complications were reported. A short delay of 2 to 6 days with antibiotic coverage is a safe strategy for managing potential or recognized injury to the gastrointestinal tract during laparoscopic ventral hernia repair.

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