73 Postoperative Outcomes After Mesh Hernia Repair in Inflammatory Bowel Disease

Background: Patients with inflammatory bowel disease (IBD), particularly those with a history of major abdominal surgery, are at increased risk for developing hernias. Although mesh is commonly used in hernia repair, its use in IBD patients remains controversial due to concerns about infection, impaired wound healing, and complications related to prior intestinal surgery. This study aimed to compare postoperative outcomes of hernia repair with mesh in 2 high-risk IBD populations: (1) Patients with ulcerative colitis (UC) with a history of ileal pouch-anal anastomosis (IPAA), and (2) Patients with Crohn’s disease (CD) with a history of CD-related abdominal surgery. Methods: We conducted a retrospective cohort study using TriNetX, evaluating UC patients with prior IPAA and CD patients with prior abdominal surgery, comparing mesh hernia repair to propensity score–matched controls who did not undergo hernia repair surgery with mesh. Propensity score matching (1:1) was performed within each cohort, adjusting for age, sex, race, body mass index, nicotine dependence, malnutrition, diabetes, chronic kidney disease, opioid use, and use of biologics or JAK inhibitors. Outcomes included wound disruption, fistula or abscess, bowel obstruction/ileus, sepsis, and postoperative biologic use; in UC patients, also pouch complications, diarrhea/fecal incontinence, and new end ileostomy rates, all assessed over a 5-year follow-up. Patients with a documented outcome prior to the hernia repair were excluded. Results: After propensity score matching, 331 UC patients with prior IPAA who underwent mesh hernia repair were compared to 331 matched UC pouch patients without hernia surgery. Rates were: wound disruption 7.2% vs 5.0% (P = 0.27), fistula/peritoneal abscess 6.5% vs 7.4% (P = 0.71), bowel obstruction/ileus 25.4% vs 24.9% (P = 0.92), sepsis 7.4% vs 8.9% (P = 0.53), biologic use after index 5.0% vs 4.4% (P = 0.73), pouchitis 10.5% vs 17.1% (RR 0.61; P = 0.019), other pouch complications 3.5% vs 4.7% (RR 0.76; P = 0.48), diarrhea/fecal incontinence 25.7% vs 24.0% (P = 0.72), and new end ileostomy ≤3.5% vs 4.0% (P > 0.05). In CD, 562 mesh hernia repair patients were compared to 562 matched controls. Rates were: wound disruption 7.6% vs 4.4% (RR 1.73; P = 0.033), fistula/peritoneal abscess 9.8% vs 5.0% (RR 1.97; P = 0.016), bowel obstruction/ileus 20.1% vs 9.8% (RR 2.05; P = 0.0046), sepsis 6.1% vs 3.6% (RR 1.68; P = 0.094), and biologic therapy initiation 14.1% vs 8.5% (RR 1.67; P = 0.035). Conclusions: In this real-world study, UC patients with prior IPAA who underwent mesh hernia repair did not experience significant increase in adverse postoperative outcomes. In contrast, CD patients with prior abdominal surgery had higher risk of fistula or abscess, bowel obstruction or ileus, wound disruption, and postoperative initiation of biologic therapy following mesh repair.