Prospective Evaluation of Adhesion Characteristics to Intraperitoneal Mesh and Adhesiolysis-related Complications During Laparoscopic Re-exploration After Prior Ventral Hernia Repair

Overview

Journal Surg Endosc

Publisher Springer

Specialties Gastroenterology
General Surgery
Radiology

Date 2010 May 7

PMID 20445995

Citations 32

Authors

Eric D Jenkins

Victoria Yom

Lora Melman

L Michael Brunt

J Christopher Eagon

Margaret M Frisella

Brent D Matthews

Affiliations

Soon will be listed here.

Abstract

Background: The purpose of this study was to characterize the adhesion characteristics of absorbable- and nonabsorbable-barrier-coated meshes and to report adhesiolysis-related complications during laparoscopic re-exploration after prior ventral hernia repair.

Methods: Under an IRB-approved protocol, patients undergoing laparoscopic re-exploration after prior intraperitoneal mesh placement were prospectively graded intraoperatively for adhesion tenacity (0-4), adhesion surface area (0 = 0%, 10 = 100%), and ratio of adhesiolysis time to mesh surface area (min/cm(2)). Adhesiolysis-related complications were also recorded. Data are given as mean ± SD. Statistical significance (P < 0.05) was determined using the t test and Fisher's exact test.

Results: From March 2006 to March 2009, 69 patients underwent laparoscopic surgery after prior intraperitoneal mesh placement for ventral hernia repair. Previous meshes were absorbable-barrier-coated mesh (n = 18), permanent-barrier composite mesh [Composix® (n = 17)], permanent-barrier noncomposite mesh [DualMesh® (n = 14)], uncoated polypropylene mesh (n = 12), and biologic mesh (n = 8). Indications for laparoscopic re-exploration were recurrent ventral hernia (n = 58), chronic pain (n = 3), cholecystectomy (n = 3), parastomal hernia (n = 2), small bowel obstruction (n = 1), nephrectomy (n = 1), and Nissen fundoplication (n = 1). Adhesions to DualMesh were less tenacious (P < 0.05) compared to all other meshes. Surface area of adhesions to DualMesh were less (P < 0.05) than to Composix and to uncoated polypropylene mesh, but not to absorbable-barrier-coated and biologic meshes. Adhesiolysis time:mesh surface area was less (P < 0.05) for DualMesh compared to Composix, uncoated polypropylene, and biologic mesh, but not to absorbable-barrier-coated mesh. Adhesiolysis-related complications occurred in two (16.7%) (P = ns) patients with uncoated polypropylene mesh, one cystotomy and one enterotomy; both were repaired laparoscopically. There were two (16.7%) (P = ns) conversions to an open procedure: one converted patient had Composix (6.7%) and one had absorbable-barrier-coated mesh (5.9%). There were no adhesiolysis-related complications with these meshes. There were no adhesiolysis-related complications or conversions to open in the DualMesh or biologic mesh groups.

Conclusions: Adhesion characteristics of mesh placed intraperitoneally and adhesiolysis-related complications during laparoscopic re-exploration after ventral hernia repair are associated with unique properties of the mesh and/or barrier.

Citing Articles

Characterization and evaluation of a fabricated absorbable poly(vinyl alcohol)-based hernia mesh.

Dorkhani E, Darzi B, Foroutani L, Soltani Z, Ahmadi Tafti S Heliyon. 2023; 9(11):e22279.

PMID: 38045132 PMC: 10689958. DOI: 10.1016/j.heliyon.2023.e22279.

An improved approach of totally visceral sac separation (TVS) for incisional hernia compared with laparoscopic intraperitoneal onlay mesh plus repair (IPOM plus).

Zhuang B, Zheng L, Yu S, Li G Sci Rep. 2023; 13(1):18037.

PMID: 37865652 PMC: 10590371. DOI: 10.1038/s41598-023-45192-2.

Experimental evaluation of the use of starch and carboxymethylcellulose in the prevention of intraperitoneal adhesions in hernia surgery with coated meshes.

Santos Filho P, Hirano E Acta Cir Bras. 2023; 38:e383323.

PMID: 37729350 PMC: 10508194. DOI: 10.1590/acb383323.

Primary Ventral Hernia Repair and the Risk of Postoperative Small Bowel Obstruction: Intra Versus Extraperitoneal Mesh.

Goullieux M, Abo-Alhassan F, Vieira-Da-Silva R, Lauranne P, Guiraud A, Ortega-Deballon P J Clin Med. 2023; 12(16).

PMID: 37629383 PMC: 10455485. DOI: 10.3390/jcm12165341.

Efficacy of extended view totally extra peritoneal approach versus laparoscopic intraperitoneal on lay mesh plus for abdominal wall hernias: a single center preliminary retrospective study.

Xu H, Huang W, Guo Y, Li M, Peng G, Wu T BMC Surg. 2023; 23(1):200.

PMID: 37443007 PMC: 10339658. DOI: 10.1186/s12893-023-02098-0.

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