Previously implanted intra-peritoneal mesh increases morbidity during re-laparoscopy: a retrospective, case-matched cohort study
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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.
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.
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.
Intra-peritoneal mesh placement is associated with adhesion formation that may increase risk during subsequent laparoscopic surgery.
KeywordsIntra-peritoneal mesh Post-operative adhesions Laparoscopic re-intervention Re-laparoscopy Adhesiolysis/access injuries Total adhesion score (TAS)
We would gratefully like to acknowledge the contributions of Dr. Abhaya Indrayan and Ms. Laxmi Raghuvanshi to the statistical analysis of the data in this paper.
Compliance with ethical standards
Conflict of interest
Dr. AS has no conflicts of interest to declare. Dr. PC has no conflicts of interest to declare. Dr. NSK has no conflicts of interest to declare. Dr. MB has no conflicts of interest to declare. Dr. VS has no conflicts of interest to declare. Dr. RK has no conflicts of interest to declare.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Human and animal rights
This study is a retrospective database analysis, and hence does not involve human or animal research.
For this type of study formal consent is not required.
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