Minimal adhesions to ePTFE mesh after laparoscopic ventral incisional hernia repair: reoperative findings in 65 cases.

Abstract

BACKGROUND AND OBJECTIVES:

Laparoscopic ventral incisional hernia repair involves intraabdominal placement of a synthetic mesh, and the possibility of formation of severe visceral adhesions to the prosthesis is a principal concern. Little clinical information based on reoperative findings is available about adhesions to biomaterials placed intraabdominally. We conducted a multi-institutional study of adhesions to implanted expanded polytetrafluoroethylene (ePTFE) mesh at reoperation in patients who had previously undergone laparoscopic incisional hernia repair done with the same mesh implantation technique.

METHODS:

Nine surgeons retrospectively assessed the severity of adhesions to ePTFE mesh at reoperation in 65 patients. For each case, adhesions were assigned a score of 0 to 3, with 0 indicating no adhesions and 3 severe adhesions.

RESULTS:

The mean time from mesh implantation to reoperation was 420 days (range, 2-1 739 days). No adhesions were observed in 15 cases. Forty-four cases received an adhesion score of 1, and 6 cases a score of 2; no scores of 3 were assigned. Thus, 59 patients (91 %) had either no or filmy, avascular adhesions. No enterotomies occurred during adhesiolysis.

CONCLUSIONS:

In this large series of reoperations after laparoscopic incisional hernia repair, no or minimal formation of adhesions to implanted ePTFE mesh was observed in 91 % of cases, and no severe cohesive adhesions were found. Comparative analyses of newer materials based on clinical reoperative findings are warranted to assess the safety of intraabdominally placed meshes.

• Authors: R H Koehler, D Begos, D Berger, S Carey, K LeBlanc, A Park, B Ramshaw, R Smoot, G Voeller
• Journal: Zentralblatt fur Chirurgie (Zentralbl Chir) Vol. 128 Issue 8 Pg. 625-30 (Aug 2003) ISSN: 0044-409X [Print] Germany
• PMID: 12931256 (Publication Type: Comparative Study, Journal Article, Multicenter Study)

Chemical References

• Polytetrafluoroethylene
• Titanium

Topics

• Adult
• Aged
• Aged, 80 and over
• Female
• Follow-Up Studies
• Hernia, Inguinal (surgery)
• Hernia, Ventral (surgery)
• Humans
• Laparoscopy
• Male
• Middle Aged
• Polytetrafluoroethylene (adverse effects)
• Postoperative Complications (etiology)
• Reoperation
• Retrospective Studies
• Safety
• Surgical Mesh (adverse effects)
• Surveys and Questionnaires
• Time Factors
• Tissue Adhesions (etiology)
• Titanium