To explore the risk factors for intestinal obstruction after laparoscopic ventral incisional hernia repair with synthetic anti-adhesion mesh, and summarize relevant prevention and treatment strategies.

A total of 296 patients who underwent laparoscopic ventral incisional hernia repair using synthetic anti-adhesion mesh from September 2018 to March 2024 were enrolled as research subjects. Patients were divided into the intestinal obstruction group (n=35) and the non-intestinal obstruction group (n=261) according to whether postoperative intestinal obstruction occurred. Statistical analyses were conducted with SPSS 22.0 software. The least absolute shrinkage and selection operator (LASSO) regression was adopted to screen potential influencing factors of postoperative intestinal obstruction. Multivariate Logistic regression was used to identify independent risk factors, and fitting curves were plotted to analyze the correlation between each risk factor and the incidence of postoperative intestinal obstruction. A predictive model was established based on the screened risk factors, and the diagnostic performance of the model was evaluated. A P value less than 0.05 was defined as statistically significant.

The average age of the 296 patients was (62.5±14.6) years old. Among them, 66 cases (22.3%) were complicated with ascites, 62 cases (20.9%) with chronic cough, 35 cases (11.8%) with chronic constipation, 38 cases (12.8%) with benign prostatic hyperplasia, and 95 cases (32.1%) without any comorbidities. Compared with the non-intestinal obstruction group, the intestinal obstruction group presented significantly prolonged time to recovery of intestinal peristalsis and bowel sounds, first flatus, first defecation and first oral feeding, impaired intestinal function, and elevated levels of β-endorphin (β-EP); meanwhile, the levels of motilin, gastrin, insulin (InS), growth hormone (GH) and total antioxidant capacity (T-AOC) were markedly decreased (P<0.05). LASSO regression and multivariate Logistic regression analyses demonstrated that body mass index (BMI), hernia defect size, operative duration, and factors leading to elevated intra-abdominal pressure were independent risk factors for postoperative intestinal obstruction (all (P<0.05). Fitting curve analysis indicated that the incidence of postoperative intestinal obstruction was positively correlated with BMI, hernia defect size and operative duration. A predictive model was constructed, and receiver operating characteristic (ROC) curve analysis revealed that the area under the curve (AUC) of this model was 0.825 [95% confidence interval (95%CI): 0.775~0.899], with a sensitivity of 0.846 and a specificity of 0.699.

Patients with BMI >25 kg/m², hernia defect size ≥8 cm, operative duration ≥120 min, or predisposing factors for elevated intra-abdominal pressure carry a high risk of intestinal obstruction after laparoscopic ventral incisional hernia repair with synthetic anti-adhesion mesh. Early clinical interventions should be implemented to reduce the incidence of this postoperative complication.