Eighty-five redo surgeries after 733 laparoscopic treatments for ventral and incisional hernia: adhesion and recurrence analysis

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Abstract
This report reviews the clinical and functional outcomes of implanted meshes during a second-look evaluation of 85 cases after a large number (733) of laparoscopic incisional and ventral hernia repairs (LIVHR), of which 608 were controlled throughout a period of 5 to 10 years. This report demonstrates a minimal occurrence of adhesions and a low rate of recurrences and other complications related to mesh usage. Eighty-five re-operated cases after LIVHR were reviewed retrospectively. In every redo surgery, the first trocar was always inserted on a lateral side, external to the previous skin incisions of the transabdominal fixations. Mueller’s adhesion scale was used to estimate adhesion severity (Mueller 0 indicates no adhesion; Mueller I indicates adhesion of the omentum; and Mueller II indicates serosal adhesions). The mechanism of recurrence is of paramount interest and is analyzed herein. If recurrence was observed, the defect was closed and a larger mesh of Parietex™ was implanted under the previous one, with transparietal fixation achieved by pulling the threads with the Endoclose® device. In all of our “second-look” surgeries, the neoperitoneum perfectly covered the mesh. In 47.05% of the cases, we observed no adhesions (Mueller 0), 42.3% had adhesions of the omentum (Mueller I), and 10.58% had serosal adhesions (Mueller II). There was no shrinking or wrinkling of the prosthesis in any of the cases, confirming its total peritonization on the anterior abdominal wall. Within the first 3 years, only 4.1% of the controlled patients contracted recurrences, with a mean follow-up of 52 months. With the double-suturing technique used for LIVHR and the use of a composite mesh, we observed a low rate of recurrences and limited side effects as compared with the use of tacks intra-abdominally. Redo surgeries after LIVHR are feasible, but care must be taken due to unpredictable mesh adhesions.
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