title: Prospective evaluation of adhesion characteristics to intraperitoneal mesh and adhesiolysis-related complications during laparoscopic re-exploration after prior ventral hernia repair.
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/cm(2)). 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.
authors.affiliation: 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.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Jenkins
authors.forename: Victoria
authors.initials: V
authors.lastname: Yom
authors.forename: Lora
authors.initials: L
authors.lastname: Melman
authors.forename: L Michael
authors.initials: LM
authors.lastname: Brunt
authors.forename: J Christopher
authors.initials: JC
authors.lastname: Eagon
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Frisella
authors.forename: Brent D
authors.initials: BD
authors.lastname: Matthews
mesh_terms: D000328:Adult; D000368:Aged; D006555:Hernia, Ventral / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008875:Middle Aged; D009852:Omentum; D010532:Peritoneal Diseases / Q000209:etiology* / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D013526:Surgical Mesh / Q000009:adverse effects*; D000267:Tissue Adhesions / Q000209:etiology / Q000601:surgery; D014781:Viscera
references.citation: Surg Innov. 2009 Mar;16(1):46-54
references.pmid: 19124448
references.citation: Hernia. 2005 Mar;9(1):68-74
references.pmid: 15578245
references.citation: Surg Endosc. 1999 Jan;13(1):10-3
references.pmid: 9869679
references.citation: JSLS. 2003 Oct-Dec;7(4):335-40
references.pmid: 14626400
references.citation: Ann Surg. 2003 Sep;238(3):391-9; discussion 399-400
references.pmid: 14501505
references.citation: Br J Surg. 2000 Apr;87(4):467-71
references.pmid: 10759744
references.citation: Chirurgie. 1985;111(3):215-25
references.pmid: 2934236
references.citation: J Surg Res. 2005 Feb;123(2):227-34
references.pmid: 15680383
references.citation: Surg Endosc. 2007 Mar;21(3):378-86
references.pmid: 17180261
references.citation: Ann Surg. 1996 Mar;223(3):242-8
references.pmid: 8604903
references.citation: Arch Surg. 2008 Jun;143(6):582-6
references.pmid: 18559752
references.citation: World J Surg. 1989 Sep-Oct;13(5):545-54
references.pmid: 2683400
references.citation: Ann Surg. 2004 Oct;240(4):578-83; discussion 583-5
references.pmid: 15383785
references.citation: Ann Surg. 2003 Jan;237(1):123-8
references.pmid: 12496539
references.citation: World J Surg. 2007 Feb;31(2):423-9; discussion 430
references.pmid: 17180562
references.citation: Surg Laparosc Endosc. 1993 Feb;3(1):39-41
references.pmid: 8258069
references.citation: Hernia. 2003 Jun;7(2):85-8
references.pmid: 12820030