title: Subsequent abdominal surgery after laparoscopic ventral and incisional hernia repair with an expanded polytetrafluoroethylene mesh: a single institution experience with 72 reoperations.
abstract: OBJECTIVE
  Laparoscopic ventral and incisional hernia repair (LVIHR) carries a risk of adhesion formation and can influence subsequent abdominal operations (SAOs). We performed a retrospective study of findings during reoperations of patients who had previously had an LVIHR by using an expanded polytetrafluoroethylene mesh (DualMesh; WL Gore, Flagstaff, AZ, USA).
  
  
  METHODS
  The medical records of all 695 patients who had LVIHR at our hospital were reviewed. Patients who underwent SAO for various indications were identified (n = 72) and analyzed.
  
  
  RESULTS
  Seven LVIHR patients (1%) had early SAO (within a few days). In six patients (86%), removal of the mesh was required. Intra-operatively, in all six of these patients with peritonitis, there were no adhesions against the implant identified. Late SAOs (after more than 1 month) were performed in 65 patients (9.4%). Only one patient required acute surgical intervention due to an LVIHR-related adhesion (0.15%). Laparoscopy was performed in 83% and laparotomy in 17% of patients. Adhesions against the implant were present in 83% of patients; in 65%, the adhesions involved omentum only, and in 18%, they involved the bowel. Adhesiolysis was always easy and caused no inadvertent enterotomies. SAOs were devoid of postoperative complications.
  
  
  CONCLUSIONS
  In this largest series of reoperations after LVIHR, the majority of patients had mild or moderate adhesions against the implant. The specific observations that: (1) no relaparoscopies had to be converted, (2) no inadvertent enterotomies were made during adhesiolysis, and (3) SAOs have practically been devoid of peri- and postoperative complications indicate that SAOs can be safely performed after previous LVIHR with DualMesh.
authors.affiliation: Department of Surgery, Twenteborg Hospital, Postbox 7600, 7600 SZ, Almelo, The Netherlands. ebwassenaar@me.com
authors.forename: E B
authors.initials: EB
authors.lastname: Wassenaar
authors.forename: E J P
authors.initials: EJ
authors.lastname: Schoenmaeckers
authors.forename: J T F J
authors.initials: JT
authors.lastname: Raymakers
authors.forename: S
authors.initials: S
authors.lastname: Rakic
mesh_terms: D020878:Device Removal; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D011138:Polytetrafluoroethylene; D011183:Postoperative Complications / Q000453:epidemiology; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013526:Surgical Mesh; D000267:Tissue Adhesions / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D011138:Polytetrafluoroethylene