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Application of a New Mesh Fixation Method in Laparoscopic Incisional Hernia Repair
Published on: December 23, 2022
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Previously implanted intra-peritoneal mesh increases morbidity during re-laparoscopy: a retrospective, case-matched
A Sharma1, P Chowbey1, N S Kantharia2
1Max Institute of Minimal Access, Metabolic & Bariatric Surgery, Max Super Speciality Hospital (East Block), 2, Press Enclave Road, Saket, New Delhi, 110017, India.
Hernia : the Journal of Hernias and Abdominal Wall Surgery
|November 20, 2017
Summary
Intra-peritoneal mesh placement for laparoscopic ventral hernia repair (LVHR) can lead to adhesions, increasing risks during re-intervention. Subsequent surgeries show higher complication rates and longer operative times due to these adhesions.
Area of Science:
- General Surgery
- Minimally Invasive Surgery
- Surgical Complications
Background:
- Laparoscopic ventral hernia repair (LVHR) with intra-peritoneal mesh is a standard treatment for abdominal wall hernias.
- Adhesion formation after intra-peritoneal mesh placement is a known complication.
- The impact of these adhesions on subsequent laparoscopic re-interventions requires further investigation.
Purpose of the Study:
- To examine adhesions formed after intra-peritoneal mesh placement during laparoscopic re-intervention.
- To ascertain the morbidity and risk of adverse events associated with these adhesions.
- To compare adhesion characteristics and surgical outcomes between patients with previous mesh, previous abdominal surgery, and no prior surgery.
Main Methods:
- Retrospective, case-matched comparison of three groups: previous intra-peritoneal mesh (Group A), previous abdominal surgery (Group B), and no previous surgery (Group C).
- Adhesion severity was quantified using a Total Adhesion Score (TAS) based on grade, extent, quadrant involvement, and dissection technique.
- Outcomes included access/adhesiolysis-related injuries, additional port requirement, operative time, and length of hospital stay.
Main Results:
- Adhesion characteristics were most severe in Group A (previous intra-peritoneal mesh).
- Access injuries occurred in 5% of Group A vs. 4% (Group B) and 1.3% (Group C). Adhesiolysis-related injury rates were 9% (Group A) vs. 2.6% (Group B).
- Group A had a 4-fold relative risk of adverse events, higher additional port requirements, and significantly longer operative times and hospital stays.
Conclusions:
- Intra-peritoneal mesh placement is associated with significant adhesion formation.
- These adhesions can increase the risk of complications and prolong operative time during subsequent laparoscopic procedures.
- Careful consideration of adhesion-related risks is warranted for patients undergoing re-intervention after LVHR with intra-peritoneal mesh.
Keywords:
Adhesiolysis/access injuriesIntra-peritoneal meshLaparoscopic re-interventionPost-operative adhesionsRe-laparoscopyTotal adhesion score (TAS)
