Previously implanted intra-peritoneal mesh increases morbidity during re-laparoscopy: a retrospective, case-matched cohort study.

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  • Additional Information
    • Source:
      Publisher: Springer Country of Publication: France NLM ID: 9715168 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1248-9204 (Electronic) Linking ISSN: 12489204 NLM ISO Abbreviation: Hernia Subsets: MEDLINE
    • Publication Information:
      Original Publication: Paris, France : Springer, c1997-
    • Subject Terms:
      Herniorrhaphy*/adverse effects ; Herniorrhaphy*/instrumentation ; Herniorrhaphy*/methods ; Laparoscopy*/adverse effects ; Laparoscopy*/methods ; Tissue Adhesions*/diagnosis ; Tissue Adhesions*/etiology ; Tissue Adhesions*/surgery; Abdominal Wall/*surgery ; Hernia, Ventral/*surgery ; Surgical Mesh/*adverse effects; Cohort Studies ; Female ; Hernia, Ventral/epidemiology ; Humans ; India/epidemiology ; Length of Stay/statistics & numerical data ; Male ; Middle Aged ; Operative Time ; Outcome and Process Assessment, Health Care ; Prostheses and Implants ; Reoperation/adverse effects ; Reoperation/methods ; Reoperation/statistics & numerical data ; Retrospective Studies
    • Abstract:
      Purpose: Laparoscopic ventral hernia repair (LVHR) with intra-peritoneal mesh placement is standard surgical treatment of abdominal wall hernias. During laparoscopic re-intervention, we examined adhesions that develop after previous intra-peritoneal mesh placement and ascertained morbidity and risk of adverse events.
      Methods: This is a retrospective, case-matched comparison of three patient groups-previous intra-peritoneal mesh (Group A), previous abdominal surgery (Group B) and no previous abdominal surgery (Group C). Matching was based on surgical procedure performed during laparoscopic re-intervention in Group A. Adhesions were described as grade, extent of previous mesh/scar involvement, involvement of abdominal quadrants and dissection technique required for adhesiolysis, each component being assigned value from 0 to 4. Total adhesion score (TAS) was generated as summative score for each patient (0 to 16). Access/adhesiolysis-related injuries, additional port requirement, deviations from planned surgery, operative time and length of hospital stay was noted. Relative risk of adverse events, i.e., inadvertent injuries and deviations from planned surgery, was calculated for Group A.
      Results: Adhesion characteristics were most severe (highest TAS) in Group A. Access injuries occurred in 5, 4, 1.3% in Groups A, B, C, respectively. Adhesiolysis-related injury rate was 9%, 2.6% in Groups A, B, respectively. Relative risk of adverse events was 4 for Group A (compared to Groups B and C combined). Additional port requirement was highest for Group A. Mean operative time and length of hospital stay was significantly longer in Group A for LVHR.
      Conclusions: Intra-peritoneal mesh placement is associated with adhesion formation that may increase risk during subsequent laparoscopic surgery.
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    • Contributed Indexing:
      Keywords: Adhesiolysis/access injuries; Intra-peritoneal mesh; Laparoscopic re-intervention; Post-operative adhesions; Re-laparoscopy; Total adhesion score (TAS)
    • Publication Date:
      Date Created: 20171120 Date Completed: 20190315 Latest Revision: 20191210
    • Publication Date:
      20240829
    • Accession Number:
      10.1007/s10029-017-1686-8
    • Accession Number:
      29151228