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

Authors :
David H. Berger
Roy Smoot
Karl A. LeBlanc
Guy R. Voeller
Steve Carey
Dennis Begos
Richard H. Koehler
Bruce Ramshaw
Adrian Park
Source :
JSLS : Journal of the Society of Laparoendoscopic Surgeons
Publication Year :
2003
Publisher :
Georg Thieme Verlag KG, 2003.

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, 2-1739 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.

Details

ISSN :
14389592 and 0044409X
Volume :
128
Database :
OpenAIRE
Journal :
Zentralblatt für Chirurgie
Accession number :
edsair.doi.dedup.....c466f199527f1c06f7c561280c4896b4