title: Minimal adhesions to ePTFE mesh after laparoscopic ventral incisional hernia repair: reoperative findings in 65 cases.
abstract: OBJECTIVE
  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.
authors: Springfield Hospital, Springfield, Vermont 05156, USA. islandmd@vermontel.net
authors: Richard H
authors: RH
authors: Koehler
authors: Dennis
authors: D
authors: Begos
authors: Dieter
authors: D
authors: Berger
authors: Steve
authors: S
authors: Carey
authors: Karl
authors: K
authors: LeBlanc
authors: Adrian
authors: A
authors: Park
authors: Bruce
authors: B
authors: Ramshaw
authors: Roy
authors: R
authors: Smoot
authors: Guy
authors: G
authors: Voeller
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene / Q000009:adverse effects*; D012086:Reoperation; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013526:Surgical Mesh / Q000009:adverse effects*; D000267:Tissue Adhesions / Q000209:etiology*
chemical_list: D011138:Polytetrafluoroethylene