Laparoscopic incisional and ventral herniorrhaphy in 100 patients

LeBlanc, Karl A.; Booth, W V; Whitaker, J. M.; Bellanger, Drake E.

doi:10.1016/s0002-9610(00)00443-8

Cited by 136 publications

(98 citation statements)

References 17 publications

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“…Two thirds of the cases [13,14] were managed conservatively and 7 cases (4.5%) had further surgery. All cases [7] were explored laparoscopically to try and diagnose the cause of pain. The earliest re-operation for adhesions was 4 months after the initial hernia surgery.…”

Section: Resultsmentioning

confidence: 99%

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Polyvinylidene Fluoride-coated Polypropylene Mesh for Intraperitoneal Onlay Mesh (IPOM) Repair of Ventral and Incisional Herniae

Sitaramachandra¹

2015

J Gastrointest Dig Syst

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Background: Dynamesh is a Polyvinylidene fluoride-coated polypropylene mesh. Its main use is for ventral hernia repairs as an on-lay mesh. The mesh was designed to have similar elasticity to the abdominal wall. It is reported to have good anti-adhesive properties while the large pores ensure rapid integration into the abdominal wall. A small series last year reported a high rate of complications with such a mesh. We have used this mesh with few anecdotal concerns and therefore present a more formal retrospective study of complications in our series.

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Section: Resultsmentioning

confidence: 99%

“…A natural progression of this was to insert the mesh in the peritoneal cavity, as close to the defective posterior sheath as possible. Fear of mesh related intestinal complications lead to the development of intraperitoneal on lay meshes (IPOM), with anti-adhesive properties [7,8].…”

Section: Introductionmentioning

confidence: 99%

Polyvinylidene Fluoride-coated Polypropylene Mesh for Intraperitoneal Onlay Mesh (IPOM) Repair of Ventral and Incisional Herniae

Sitaramachandra¹

2015

J Gastrointest Dig Syst

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“…Other reports of laparoscopic repairs reveal similar experiences. 11,17,27 If an absorbable mesh is inserted along with a nonabsorbable prosthesis to prevent temporary contact between the nonabsorbable material and the viscera-a method recommended by Wantz 3 and others 28 -the time during which peritoneal coverage is provided is a concern. One study of adhesion formation in a rat model suggested that most adhesions were fully developed by 7 days after implantation of mesh 29 ; however, Amid 30 expressed caution against such results that suggest a temporary barrier is needed for only a short time.…”

Section: Discussionmentioning

confidence: 99%

“…This mesh is composed of 2 layers of ePTFE with different surface characteristics; one layer has a "smooth," nonporous surface to be placed against the viscera to limit adhesions and the other has a "rough" surface with large interstices in the material (22 µm) to encourage tissue ingrowth. DualMesh has so far been used in more than 1000 laparoscopic ventral and incisional hernia repairs, 11,26,27,31,32 with good results with respect to recurrences and complications. The current study of 65 reoperations supports the assumption that no or minimal adhesions result from the use of DualMesh in such procedures.…”

Section: Discussionmentioning

confidence: 99%

Minimal adhesions to ePTFE mesh after laparoscopic ventral incisional hernia repair: reoperative findings in 65 cases

et al. 2003

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Objectives: 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 mate- INTRODUCTIONThe need for reinforcement of the abdominal wall by implantation of synthetic materials during repair of abdominal incisional hernias is well established. [1][2][3][4] Moreover, because early use of various biomaterials in ventral incisional hernia repair resulted in some serious complications, including fistulization due to adhesions, 5-7 it is clear that avoiding contact between the mesh and viscera is desirable. 2,3,8,9 In laparoscopic incisional herniorrhaphy, however, first described by LeBlanc and Booth in 1993, 10 placement of the mesh in the intraabdominal position is necessary. Thus, this procedure requires a biomaterial that provides both adequate strength and a minimal risk of severe adhesion formation that could result in bowel obstruction or fistula development.Numerous studies of the formation of adhesions to biomaterials placed intraabdominally have been conducted in animals, but few investigations of this issue have been based on information obtained at reoperation in patients. Moreover, no large study has examined reoperative observations pertaining to adhesions to a biomaterial after laparoscopic incisional hernia repair specifically. Therefore, we conducted a retrospective review of findings at reoperation in patients who had undergone such a repair and in whom a 1-mm-thick expanded polytetrafluoroethylene (ePTFE) dual-surface mesh (DualMesh, W.L. Gore & Associates, Flagstaff, AZ) had been implanted during the repair. METHODS Records

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“…28 Goodney and colleagues 28 29 the first to describe laparoscopic incisional herniorrhaphy, reported results at an average follow-up of 51 months in the first 100 patients. Major complications occurred in 4.1% of the patients with a recurrence of 9.3%.…”

Section: The Laparoscopic Approachmentioning

confidence: 99%

The Management of Incisional Hernia

Kingsnorth

2006

annals

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Ann R Coll Surg Engl 2006; 88: 252-260 252Medline and Embase were searched using the search terms 'hernia' and 'incisional' alone and in combination. Publications were selected mostly in the past 5 years, but did not exclude commonly reference and highly regarded older publications. The reference list of articles was also searched, identified by the search strategy and those selected that were relevant. Selected review articles and metaanalyses were included because they provide comprehensive overviews that may be beyond the scope of this article. OverviewThe introduction of prosthetic mesh revolutionised the treatment of groin hernia but, to date, has had little impact on the treatment of incisional hernia.1 The risk factors for the development of incisional hernia include obesity, diabetes, emergency surgery, postoperative wound dehiscence, smoking and postoperative wound infection. 2,3The risks of repairing an incisional hernia which should be explained to the patient when obtaining consent include seroma formation, wound infection, injury to intraabdominal structures and recurrence. 4 Major complications which can occur in repair of large incisional hernias include mesh infection and enterocutaneous fistula which may result in prolonged morbidity and require re-operation (Fig. 1). It is now accepted that only the smallest (less than 3 cm) incisional hernias should be repaired with primary tissue approximation with sutures and this topic will not be discussed further.5 Small incisional hernias with time develop into larger incisional hernias due to the continuous presence of intra-abdominal hydrostatic pressure of 15 cm of water, diaphragmatic contractions occurring with respiration, increases in abdominal pressure occurring with coughing and straining realising pressures of over 80 cm of water and myofascial retraction of the lateral muscles. As a result, the abdominal cavity contracts and the right of domicile for the herniated visceral mass is lost. 6 Due to several previous operations, many of these patients have poor-quality abdominal wall musculature which, coupled with multiple co-morbid medical problems, present a surgical and anaesthetic challenge.Surgeons appear to have a reluctance to operate on incisional hernias perhaps because of the poor general condition of the patients but perhaps also due to lack of knowledge of how to deal with the various defects occurring as a result of incisions of the anterior abdominal wall and the operative techniques required. For instance, although it is estimated that 13% of laparotomy incisions fail in The Netherlands, only 4% of patients undergoing a laparotomy will go through additional surgery to repair an incisional hernia.7 Suture repair is likely to produce results twice as bad as mesh repair and the current techniques that surgeons are using to repair incisional hernias with prosthetic mesh continue to yield recurrence rates of greater than 20%. Many thousand laparotomy incisions are created each year and the failure rate for closure of these abdominal wou...

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Laparoscopic incisional and ventral herniorrhaphy in 100 patients

Cited by 136 publications

References 17 publications

Polyvinylidene Fluoride-coated Polypropylene Mesh for Intraperitoneal Onlay Mesh (IPOM) Repair of Ventral and Incisional Herniae

Polyvinylidene Fluoride-coated Polypropylene Mesh for Intraperitoneal Onlay Mesh (IPOM) Repair of Ventral and Incisional Herniae

Minimal adhesions to ePTFE mesh after laparoscopic ventral incisional hernia repair: reoperative findings in 65 cases

The Management of Incisional Hernia

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