Abstract | 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 multiinstitutional 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 to 1739 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.
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Authors | Richard H Koehler, Dennis Begos, Dieter Berger, Steve Carey, Karl LeBlanc, Adrian Park, Bruce Ramshaw, Roy Smoot, Guy Voeller |
Journal | JSLS : Journal of the Society of Laparoendoscopic Surgeons
(JSLS)
2003 Oct-Dec
Vol. 7
Issue 4
Pg. 335-40
ISSN: 1086-8089 [Print] United States |
PMID | 14626400
(Publication Type: Journal Article)
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Chemical References |
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Topics |
- Adult
- Aged
- Aged, 80 and over
- Female
- Hernia, Ventral
(surgery)
- Humans
- Laparoscopy
(adverse effects)
- Male
- Middle Aged
- Polytetrafluoroethylene
(adverse effects)
- Reoperation
- Retrospective Studies
- Severity of Illness Index
- Surgical Mesh
(adverse effects)
- Tissue Adhesions
(etiology)
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