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Investigation of optimal hernia repair techniques in patients with inflammatory bowel disease

  • 2023 SAGES Oral
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Introduction

Multiple laparotomies, immunosuppressive therapy, wound infection, and malnutrition are risk factors for incisional hernia development, which places inflammatory bowel disease (IBD) patients at high risk. With advances in minimally invasive techniques, this study assesses incisional hernia repair techniques and complications in the IBD population.

Methods

A single-center, retrospective review of adults with IBD who underwent incisional hernia repair from 2008 to 2022. Complications relative to operative approach and mesh placement location were assessed using descriptive and univariate statistics.

Results

Eighty-eight IBD patients underwent incisional hernia repair. Fifty-two (59.1%) were on immunomodulators and 30 (34.1%) were repaired primarily. Thirty-five (39.7%) hernias recurred, of whom 19 (33%) had mesh placed. Three (30%) occurred in onlay repairs and 16 (33%) occurred in underlay repairs. Subdivision of underlay repairs into intraperitoneal, preperitoneal and retrorectus mesh placement revealed recurrence rates of 35.1%, 50%, and 14.3%, respectively. Patients with open repair were more likely to have intraoperative bowel injury (28.6% vs 9.7%, p = 0.041) and develop postoperative seromas/abscesses (12.5% vs 0%, p = 0.001) and wound complications (17.9% vs 0%, p = 0.012) compared to laparoscopic. Seromas/abscesses developed more frequently in onlay repairs compared to underlay (40% vs 2.13%, p = 0.001). Twelve (13.6%) patients presented with postoperative small bowel obstruction (SBO), 7 (58.3%) of whom had mesh placed, and 6 (85.7%) were underlay. All SBO after underlay repair had intraperitoneally placed mesh. When comparing surgeons, hernias were more likely to recur performed by colorectal surgeons compared to hernia surgeons (63.3% vs 21.3%, p < 0.001).

Conclusion

In IBD patients, minimally invasive approaches lead to fewer perioperative complications compared to open. Underlay mesh placement demonstrated decreased incidence of seroma/abscess formation compared to onlay. When sub-grouped, underlay placements were similar in terms of complications. Retrorectus placement, however, had fewer recurrences and no readmissions for SBO. This suggests a minimally invasive approach or placement of retrorectus mesh may provide the optimal repair in this patient population.

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Authors and Affiliations

  1. Department of Surgery, University of Massachusetts Chan Medical School - Baystate Medical Center, 759 Chestnut St., Springfield, MA, 01199, USA

    Nikita Ramanathan, Matthew F. Mikulski, Aixa M. Perez Coulter & Neal E. Seymour

  2. Department of Surgery, Beth Israel Lahey Health -Winchester Hospital, Boston, USA

    Georgios Orthopoulos

Authors
  1. Nikita Ramanathan
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  2. Matthew F. Mikulski
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  3. Aixa M. Perez Coulter
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  4. Neal E. Seymour
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  5. Georgios Orthopoulos
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Corresponding author

Correspondence to Nikita Ramanathan.

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Disclosures

Nikita Ramanathan, Matthew F. Mikulski, Aixa M. Perez Coulter, Neal E. Seymour, and Georgios Orthopoulos have no conflicts of interest or financial ties to disclose.

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Appendix

Appendix

ICD-10 codes for IBD:

  • K50 Crohn’s disease

  • K51 ulcerative colitis

ICD-9 codes for IBD:

  • 555.9 Crohn’s disease

  • 556.9 ulcerative colitis

Open hernia repair CPT codes:

  • 49,560 repair initial incisional or ventral hernia, reducible

  • 49,561 repair initial incisional or ventral hernia, incarcerated or strangulated

  • 49,565 repair recurrent incisional or ventral hernia, reducible

  • 49,566 repair recurrent incisional or ventral hernia, incarcerated or strangulated

Laparoscopic/robotic hernia repair CPT codes:

  • 49,654 laparoscopy, surgical, repair, incisional hernia (includes mesh insertion, when performed), reducible

  • 49,655 laparoscopy, surgical, repair, incisional hernia (includes mesh insertion, when performed), incarcerated or strangulated

  • 49,656 laparoscopy, surgical, repair, recurrent incisional hernia (includes mesh insertion, when performed), reducible

  • 49,657 laparoscopy, surgical, repair, recurrent incisional hernia (includes mesh insertion, when performed), incarcerated or strangulated

ICD-10 codes for complications:

  • K43.0 incisional hernia with obstruction, without gangrene

  • K43.1 incisional hernia with gangrene

  • K43.2 incisional hernia without obstruction or gangrene

  • K43.3 parastomal hernia with obstruction, without gangrene

  • K43.4 parastomal hernia with gangrene

  • K43.5 parastomal hernia without obstruction or gangrene

ICD 9 codes for complications:

  • 552.21 incisional hernia with obstruction

  • 553.21 incisional hernia without obstruction or gangrene

  • 551.21 incisional ventral hernia with gangrene

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Ramanathan, N., Mikulski, M.F., Perez Coulter, A.M. et al. Investigation of optimal hernia repair techniques in patients with inflammatory bowel disease. Surg Endosc 38, 975–982 (2024). https://doi.org/10.1007/s00464-023-10537-5

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  • DOI: https://doi.org/10.1007/s00464-023-10537-5

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