Venous Thromboembolism after Abdominal Wall Reconstruction: A Prospective Analysis and Review of the Literature

Abstract

Background: Ventral hernias are a common problem after exploratory laparotomy, and plastic surgeons often become involved for hernia repair in complex situations. Plastic surgeons can achieve fascial closure through primary repair, an external oblique aponeurosis release, or a transversus abdominis release. Currently, there is scant literature evaluating venous thromboembolism rates after these procedures. The authors sought to evaluate their own experience with complex abdominal wall reconstruction and venous thromboembolism events.

Methods: The authors retrospectively reviewed their prospectively collected database of all patients who have undergone complex abdominal wall reconstruction performed by a single surgeon at their institution from September of 2013 to February of 2018. Demographic data, anticoagulant use, Caprini score, operative time, and postoperative venous thromboembolism events were recorded. A literature search was also performed, identifying all published articles evaluating venous thromboembolism events after abdominal wall reconstruction.

Results: The authors identified 175 patients for analysis. Four patients were found to have postoperative venous thromboembolism events, for a total venous thromboembolism rate of 2.3 percent. The average Caprini score for these patients was 8.5, compared to 5.26 for those without a venous thromboembolism event, and no deaths were reported from these complications. On literature review, three articles were identified in the literature discussing venous thromboembolism after abdominal wall reconstruction, all based on the American College of Surgeons National Surgical Quality Improvement Program database.

Conclusions: Patients undergoing complex abdominal wall reconstruction are at high risk for venous thromboembolism events. There is scant literature published on this topic, but surgeons should be aware of the risk for venous thromboembolism after complex abdominal wall reconstruction and work to minimize this risk as much as possible.

Clinical question/level of evidence: Therapeutic, IV.