Enterotomy During Hernia Repair: Prevention and Management

An inadvertent enterotomy during a laparoscopic or open ventral hernia repair is often unavoidable. If an enterotomy occurs it is associated with an increased risk of wound infections, mesh infections, enterocutaneous fistulas, and hernia recurrences. Multiple options exist for management of the ventral hernia in a clean-contaminated or contaminated wound; however, the management of the enterotomy takes priority. A missed enterotomy increases the mortality rate after ventral hernia repair so attentiveness is paramount throughout the entire procedure and in the postoperative recovery. Although certain factors associated with an increased risk of enterotomy during ventral hernia repair are identifiable preoperatively, all patients should be advised of the risk of enterotomy and instructed of the basic decision algorithm for management of an enterotomy during the informed consent process.