Outcomes/Effectiveness Research

Unplanned bowel resections during hernia operations lead to more complications and longer stays

Surgeons who set out to repair a hernia caused by earlier surgeries (incisional hernia repair) at times end up also having to remove part of a patient's bowels (enterotomy or unplanned bowel resection). This additional procedure leads to longer operating room times, longer hospital stays, and increased chances for complications after the surgery, a new study finds.

Researchers reviewed records of 1,124 patients who were scheduled for elective incisional hernia repair between January 1998 and December 2008 at 16 Veterans Affairs medical centers. A total of 82 patients (7.3 percent) required unplanned bowel resections. Thirty-two percent of patients who had bowel resections experienced complications after surgery compared with 10 percent who did not require resections. These complications included wound infection (15), urinary tract infection (3), failing to wean from ventilators (2), kidney problems (2), sepsis (2), and deep vein thrombosis (1). Unplanned bowel resection nearly doubled operating room time, from 1.7 hours to 3.5 hours, and caused the patients to spend 4 to 10 days in the hospital instead of 2 to 6.

Researchers found a strong link between unplanned bowel resections and previous hernias that used mesh to hold in the bulging intestines. Foreign materials often cause scar tissue that can damage the intestines. The researchers recommend future studies that examine newer mesh products to see if these result in fewer bowel injuries during surgery. Long-term steroid use was also linked to unplanned bowel resections. The researchers suggest that these drugs may adversely affect the tissues of the intestine, putting them at risk for injury. They recommend patients who take steroids receive enemas before undergoing elective hernia incision repairs.

This study was funded in part by the Agency for Healthcare Research and Quality (HS13852).

See "Risk of complications from enterotomy or unplanned bowel resection during elective hernia repair," by Stephen H. Gray, M.D., Catherine C. Vick, M.S., Laura A. Graham, M.P.H., and others in the June 2008 Archives of Surgery 143(6), pp. 582-586.

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