Abstract
Prosthetic mesh for laparoscopic inguinal hernia repair has become popular but the method of its placement is controversial. Mesh placed within the peritoneum may cause adhesion formation and further complications. The aim of this study was to examine the laparoscopic placement of a mesh, comparing intraperitoneal vs extraperitoneal insertion. In a porcine model (n=15) a polypropylene mesh was placed laparoscopically over the anterior abdominal wall. On the left side the mesh was stapled on the parietal peritoneum. On the right side the peritoneum was incised, an extraperitoneal space was dissected, the mesh was inserted, and the peritoneum was closed over it. The animals were maintained for 2 weeks. At postmortem there were adhesions in two of those placed extraperitoneally and five of those placed intraperitoneally (P=0.19, Fisher's exact test). The adhesions comprised fibrous peritoneal bands to loops of small intestine. Both methods of laparoscopic mesh placement were associated with a small but significant incidence of adhesion formation.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Filipi CJ, Fitzgibbons RJ, Salerno GM, Hart RO (1992) Laparoscopic herniorrhaphy. Surg Clin North Am 72: 1109–1124
Ger R, Mishrick A, Hurwitz J. Romero C, Oddsen R (1993) Management of groin hernias by laparoscopy. World J Surg 17: 46–50
Gilbert AI (1989) An anatomic and functional classification of the diagnosis and treatment of inguinal hernia. Am J Surg 157: 331–333
Glassow F (1984) Inguinal hernia repair using local anaesthesia. R Coll Surg Engl 66: 382–387
Kavic MS (1993) Laparoscopic hernia repair. Surg Endosc 7: 153–167
Law NW, Ellis H (1991) A comparison of polypropylene mesh and expanded polytetrafluoroethylene patch for the repair of contaminated abdominal wall defects; an experimental study. Surgery 109: 652–655
Law NW, Ellis H (1988) Adhesion formation and peritoneal healing on prosthetic materials. Clin Materials 3: 95–101
MacFayden BV, Arregui ME, Corbitt JD, Filipi CJ, Fitzgibbon RJ, Franklin ME, McKernan B, Olsen D, Phillips EH, Rosenthal D, Schultz LS, Sewell RW, Smoot RT, Spaw AT, Toy FK, Waddell RL, Zucker KA (1993) Complications of laparoscopic herniorraphy. Surg Endosc 7: 155–158
McKernan JB, Laws HL (1993) Laparoscopic repair of inguinal hernias using a totally extraperitoneal prosthetic approach. Surg Endosc 7: 26–28
Nyhus LM, Klein MS, Rogers FB (1991) Inguinal hernia. In: Wells SA (ed) Current problems in surgery, vol 28. Mosby—Year Book, Littleton, MA, pp 403–450
Phillips EH, Carroll BJ, Fallas MJ (1993) Laparoscopic preperitoneal inguinal hernia repair without peritoneal incision: technique and early clinical results. Surg Endosc 7: 159–162
Sailors DM, Layman TS, Burns RP, Chandler KE, Russell WL (1993) Laparoscopic hernia repair: a preliminary report. Am Surg 59: 85–89
Author information
Authors and Affiliations
Additional information
Paper based on a communication to the European Association for Endoscopic Surgery in Cologne, Germany, June 1993
Rights and permissions
About this article
Cite this article
Attwood, S.E.A., Caldwell, M.T.P., Marks, P. et al. Adhesions after laparoscopic inguinal hernia repair. Surg Endosc 8, 777–780 (1994). https://doi.org/10.1007/BF00593439
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00593439