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Patients undergoing ventral hernia repair (VHR) are at risk of an inadvertent enterotomy during surgery. Inadvertent enterotomies potentially contaminate the surgical field presenting a management dilemma for the surgeon. The aim of our study was to define the incidence and risk factors for a recognized inadvertent enterotomy and determine its impact on short-term outcomes after ventral hernia repair.Using a nationwide hernia registry, the Americas Hernia Society Quality Collaborative, we reviewed all ventral hernia repair performed between 2013 and 2017. Patients were assessed for full-thickness inadvertent enterotomies at the time of surgery. Patients with inadvertent enterotomies and without enterotomies were compared to assess differences in 30-day outcomes, using regression modeling.A total of 5,916 patients were included. The incidence of inadvertent enterotomy was 1.9%, with no difference between open and laparoscopic approaches. Inadvertent enterotomies did not increase surgical site occurrences but there were more surgical site infections (OR: 2.20 [95% CI: 1.24–3.90], P=.007). Patients were less likely to receive mesh if there was an enterotomy. Inadvertent enterotomies led to higher rates of reoperations, readmission, enterocutaneous fistulas, and mortality.Inadvertent enterotomies are more common in complex cases of ventral hernia repair and have an overall incidence of 1.9%. These patients are at increased risk of surgical site infections, reoperations, readmission, and mortality. Although definitive hernia repair with mesh can be safely performed, surgeons should consider multiple factors, including type of mesh and location of mesh in the abdominal wall, before proceeding with definitive repair in any case of an enterotomy.