Early small bowel obstruction following abdominal wall hernia repair: Report of four cases and systematic review of the literature

Abstract

CONTEXT: Early small bowel obstruction (ESBO) is a recognized condition, but its treatment remains poorly defined. Conservative management may be attempted during abdominal wall reconstruction (AWR), but this approach can result in complications such as intra-abdominal hypertension (IAH). Considering recent cases, we conducted a systematic review of the literature and screened our database for diagnoses and treatments. MATERIALS AND METHODS: We conducted a retrospective review of our database from 2018 to 2022, searching for cases of ESBO following hernia repair. We also included international literature in English and Spanish, according to PRISMA criteria, from 2010 to 2022, using the keywords “intestinal obstruction” and “hernia repair.”RESULTS: We identified four cases in total, with three involving incisional hernias and one involving a parastomal hernia. ESBO developed in a mean of 6 days due to adhesions. Emergency surgery was required in three cases due to IAH, which was resolved with an open abdomen. One patient died, and only two patients ultimately underwent hernia repair. In our systematic review, we found 26 articles describing 54 patients with ESBO, mostly due to adhesions following laparoendoscopic inguinal repairs. Obstruction occurred on average within 6.7 days, and 65% of patients were treated with surgery, with no mortality. CONCLUSIONS: ESBO following AWRs can result in severe complications, with adhesions being the most common cause and surgical re-intervention being frequent. Our cases revealed that difficulty in expanding the abdomen during ESBO after AWR may trigger postoperative IAH, which has not been described in the literature and can lead to significant morbidity and mortality.

Keywords

• abdominal hernia
• abdominal surgery
• abdominal wall
• intestinal obstruction