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Does intraperitoneal mesh increase the risk of bowel obstruction? A nationwide French analysis

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Abstract

Introduction

Incisional hernias are associated with a reduced quality of life. Mesh reinforcement of the abdominal wall is the current standard for incisional hernia repair (IHR), since it reduces the risk of recurrence. The best position for the mesh remains controversial, and each position has advantages and disadvantages.

Objective

In this nationwide population-based study, we aimed to determine whether IHR with intraperitoneal mesh is associated with an increased risk of bowel obstruction.

Patients and methods

Using the French hospital database (PMSI), which collects data from all public and private hospitals, two patient cohorts were created and compared. Patients having undergone a laparoscopic IHR with intraperitoneal mesh (IPOM) in 2013 or 2014 due to a laparotomy performed in the 4 previous years were the IPOM group. Patients hospitalized for any other acute disease (i.e., without IHR) in 2013 and 2014, but having a similar laparotomy in the 4 previous years were the control group. Both cohorts were followed until 2019 in search of any episode of bowel obstruction.

Results

A total of 815 patients were included in the IPOM group and matched to 1630 control patients. The 5 year bowel obstruction rate was 7.36% in the IPOM group and 4.42% in the control group (p < 0.01). In the multivariate analysis, after adjustment on age and obesity, incisional hernia repair with laparoscopic IPOM increased the risk of bowel obstruction in the 5 years following surgery (HR = 1.712; 95% CI 1.208–2.427; p = 0.0025).

Conclusions

Patients having undergone laparoscopic IPOM have an increased risk of bowel obstruction compared with patients who have a similar surgical history but no IHR.

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Data availability

PMSI data are available for researchers who meet the criteria for access to these French confidential data. Access is submitted to the approval of the National Committee for data protection (CNIL) and from the national agency for the management of hospitalization (ATIH–Agence Technique de l'Information sur l'Hospitalisation). According to the French law, no individual informed consent was required for this study. All data used in this analysis were anonymous and no personal medical records were consulted.

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Funding

This study had no specific financial support. The Regional Council of Burgundy supports in a general way the research activity of the University Hospital of Dijon. This study had no specific financial support.

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Authors and Affiliations

  1. Department of Digestive Surgery, Dijon University Hospital, 14, Rue Paul Gaffarel, Dijon, 21079, France

    Théophile Delorme, Fawaz Abo-Alhassan & Pablo Ortega-Deballon

  2. Department of Medical Information, Dijon University Hospital, Dijon, France

    Jonathan Cottenet & Catherine Quantin

  3. Department of Thoracic and Cardiovascular Surgery, Dijon University Hospital, Dijon, France

    Alain Bernard

  4. INSERM, Université de Bourgogne, CHU Dijon Bourgogne, CIC 1432, Module Épidémiologie Clinique, Dijon, France

    Pablo Ortega-Deballon & Catherine Quantin

Authors
  1. Théophile Delorme
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Correspondence to Pablo Ortega-Deballon.

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Regarding the ‘Consent to participate’ and/or ‘Consent to publish’, this is a study based on an anonymous large-scale national database. There is no access to patients’ individual clinical records. According to the European and French regulation, patients do not need to consent nor to be informed.

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Delorme, T., Cottenet, J., Abo-Alhassan, F. et al. Does intraperitoneal mesh increase the risk of bowel obstruction? A nationwide French analysis. Hernia 28, 419–426 (2024). https://doi.org/10.1007/s10029-023-02885-x

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  • DOI: https://doi.org/10.1007/s10029-023-02885-x

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