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01-04-2018 | Original Article

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

Authors: A. Sharma, P. Chowbey, N. S. Kantharia, M. Baijal, V. Soni, R. Khullar

Published in: Hernia | Issue 2/2018

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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Title: Previously implanted intra-peritoneal mesh increases morbidity during re-laparoscopy: a retrospective, case-matched cohort study
Authors: A. Sharma
P. Chowbey
N. S. Kantharia
M. Baijal
V. Soni
R. Khullar
Publication date: 01-04-2018
Publisher: Springer Paris
Published in: Hernia / Issue 2/2018
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI: https://doi.org/10.1007/s10029-017-1686-8

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

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

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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