Skip to main content
SpringerLink
Log in

Prospective evaluation of adhesion characteristics to intraperitoneal mesh and adhesiolysis-related complications during laparoscopic re-exploration after prior ventral hernia repair

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

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/cm2). 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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Rives J, Pire JC, Flament JB, Palot JP, Body C (1985) Treatment of large eventrations. New therapeutic indications apropos of 322 cases. Chirurgie 111:215–225

    CAS  PubMed  Google Scholar 

  2. Stoppa RE (1989) The treatment of complicated groin and incisional hernias. World J Surg 13:545–554

    Article  CAS  PubMed  Google Scholar 

  3. Burger JW, Luijendijk RW, Hop WC, Halm JA, Verdaasdonk EG, Jeekel J (2004) Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg 240:578–583

    PubMed  Google Scholar 

  4. LeBlanc KA, Booth WV (1993) Laparoscopic repair of incisional abdominal hernias using expanded polytetrafluoroethylene: preliminary findings. Surg Laparosc Endosc 3:39–41

    CAS  PubMed  Google Scholar 

  5. Pierce RA, Spitler JA, Frisella MA, Matthews BD, Brunt LM (2006) Pooled data analysis of laparoscopic vs. open ventral hernia repair: 14 years of patient data accrual. Surg Endosc 21:378–386

    Article  PubMed  Google Scholar 

  6. Heniford BT, Park A, Ramshaw BJ, Voeller G (2003) Laparoscopic repair of ventral hernias: nine year experience with 850 consecutive hernias. Ann Surg 238:391–400

    PubMed  Google Scholar 

  7. Halm JA, de Wall LL, Steyerberg EW, Jeekel J, Lange JF (2007) Intraperitoneal polypropylene mesh hernia repair complicates subsequent abdominal surgery. World J Surg 31:423–429

    Article  CAS  PubMed  Google Scholar 

  8. Garrard CL, Clements RH, Nanney L, Davidson JM, Richards WO (1999) Adhesion formation is reduced after laparoscopic surgery. Surg Endosc 13(1):10–13

    Article  CAS  PubMed  Google Scholar 

  9. Van Der Krabben AA, Dijkstra FR, Niewenhuijzen M, Reijnen MM, Schaapveld M, Van Goor H (2000) Morbidity and mortality of inadvertent enterotomy during adhesiotomy. Br J Surg 87(4):467–471

    Article  Google Scholar 

  10. Luijendijk RW, de Lange DC, Wauters CC, Hop WC, Duron JJ, Pailler JL, Camprodon BR, Holmdahl L, van Geldorp HJ, Jeekel J (1996) Foreign material in postoperative adhesions. Ann Surg 223:242–248

    Article  CAS  PubMed  Google Scholar 

  11. Gray SH, Vick CC, Graham LA, Finan KR, Neumayer LA, Hawn MT (2008) Risk of complications from enterotomy or unplanned bowel resection during elective hernia repair. Arch Surg 143(6):582–586

    Article  PubMed  Google Scholar 

  12. Pierce RA, Perrone JM, Nimeri A, Sexton JA, Walcutt J, Frisella MM, Matthews BD (2009) 120-day comparative analysis of adhesion grade and quantity, mesh contraction, and tissue response to a novel omega-3 fatty acid bioabsorbable barrier macroporous mesh after intraperitoneal placement. Surg Innov 16:46–54

    Article  PubMed  Google Scholar 

  13. van’t Riet M, van Steenwijk PJ, Bonthuis F, Marquet RL, Steyerberg EW, Jeekel J, Bonjer HJ (2003) Prevention of adhesion to prosthetic mesh: comparison of different barriers using an incisional hernia model. Ann Surg 237:123–128

    Article  Google Scholar 

  14. Matthews BD, Mostafa G, Carbonell AM, Joels CS, Kercher KW, Austin C, Norton HJ, Heniford BT (2005) Evaluation of adhesion formation and host tissue response to intra-abdominal polytetrafluoroethylene mesh and composite prosthetic mesh. J Surg Res 123(2):227–234

    Article  CAS  PubMed  Google Scholar 

  15. Koehler RH, Begos D, Berger D, Carey S, LeBlanc K, Park A, Ramshaw B, Smoot R, Voeller G (2003) Minimal adhesions to ePTFE mesh after laparoscopic ventral hernia incisional hernia repair: re-operative findings in 65 cases. JSLS 7:335–340

    PubMed  Google Scholar 

  16. Arnaud JP, Hennekinne-Mucci S, Pessaux P, Tuech JJ, Aube C (2003) Ultrasound detection of visceral adhesion after intraperitoneal ventral hernia treatment: a comparative study of protected versus unprotected meshes. Hernia 7:85–88

    Article  CAS  PubMed  Google Scholar 

  17. Balique JG, Benchetrit S, Bouillot JL, Flament JB, Gouillat C, Jarsaillon P, Lepère M, Mantion G, Arnaud JP, Magne E, Brunetti F (2005) Intraperitoneal treatment of incisional and umbilical hernias using an innovative composite mesh: four-year results of a prospective multicenter clinical trial. Hernia 9:68–74

    Article  CAS  PubMed  Google Scholar 

Download references

Disclosures

Dr. Jenkins, Dr. Melman, Ms. Yom, and Mrs. Frisella have no conflicts of interest or financial ties to disclose. Dr. Eagon has received consultant fees from Ethicon Endosurgery. Dr. Brunt has received an honorarium for speaking/teaching, supplies for skills training, and grant support for clinical fellowship salary support from Ethicon Endosurgery; an honorarium for speaking/teaching and supplies for skills training from Covidien; grant support for education and training from both Stryker Endoscopy and Karl Storz Endoscopy; and grant support for research from Lifecell Corp. Dr. Matthews has received consulting fees from Atrium Medical, Ethicon EndoSurgery, and Muskuloskeletal Transplant Foundation, and an honorarium for speaking from W.L. Gore.

Author information

Authors and Affiliations

  1. Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box #8109, St. Louis, MO, 63110, USA

    Eric D. Jenkins, Victoria Yom, Lora Melman, L. Michael Brunt, J. Christopher Eagon, Margaret M. Frisella & Brent D. Matthews

Authors
  1. Eric D. Jenkins
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Victoria Yom
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lora Melman
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. L. Michael Brunt
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J. Christopher Eagon
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Margaret M. Frisella
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Brent D. Matthews
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Brent D. Matthews.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jenkins, E.D., Yom, V., Melman, L. et al. Prospective evaluation of adhesion characteristics to intraperitoneal mesh and adhesiolysis-related complications during laparoscopic re-exploration after prior ventral hernia repair. Surg Endosc 24, 3002–3007 (2010). https://doi.org/10.1007/s00464-010-1076-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-010-1076-0

Keywords

Search

Navigation