Adhesions After Lap Ventral: Do They Matter?

  • Dennis L. Fowler


More than 300,000 patients are admitted to the hospital each year at a cost of more than $1 billion for treatment of an adhesion-related problem. The most common cause of adhesions is previous surgery, and hernia mesh is one of the inciting causes of adhesions after surgery. Numerous composite or coated prosthetic meshes have been developed to reduce the incidence of adhesion formation after intraperitoneal placement of mesh. Animal studies have documented fewer and less dense adhesions after placement of these meshes; however, no studies in patients have proven that these composite or coated meshes result in fewer adhesion-related complications. Despite the lack of evidence from human studies, because the clinical problem is so prevalent, experimental and theoretical reasons justify use of composite or coated meshes that may reduce the incidence of adhesion formation after intraperitoneal placement of mesh.


Adhesions Bowel obstruction Ventral hernia Ventral hernia repair Laparoscopic ventral hernia repair Hernia mesh Composite mesh Coated mesh 


  1. 1.
    Ray NF, Denton WG, Thamer M, et al. Abdominal adhesiolysis: inpatient care and experience in the Unites States in 1994. JACS. 1998;186:1–9.Google Scholar
  2. 2.
    DeFrances CJ, Podgornik MN. 2004 National hospital discharge survey. Advance data from vital and healthc statistics; no 371. Hyattwsville, MD: National Center for Health Statistics. 2006.Google Scholar
  3. 3.
    Latenser B. Commentary (A novel hydrogel-coated polyester mesh prevents post-surgical adhesions in a rat model). J Surg Res. 2011;166:73–4.PubMedCrossRefGoogle Scholar
  4. 4.
    Judge TW, Parker DM, Dinsmore RC. Abdominal wall hernia repair: a comparison of Sepramesh and Parietex composite mesh in a rabbit hernia model. J Am Coll Surg. 2007;204:76.CrossRefGoogle Scholar
  5. 5.
    Emans PJ, Schreinemacher MH, Gijbels MJ, et al. Polypropylene meshes to prevent abdominal herniation. Can stable coatings prevent adhesions in the long term? Ann Biomed Eng. 2009;37:410.PubMedCrossRefGoogle Scholar
  6. 6.
    van Goor H. Consequences and complications of peritoneal adhesions. Colorectal Dis. 2007;2:25–34.CrossRefGoogle Scholar
  7. 7.
    Lower AM, Hawthorn RJ, Ellis H, O’Brien F, Buchan S, Crowe AM. The impact of adhesions on hospital readmissions over ten years after 8849 open gynaecological operations: an assessment from the Surgical and Clinical Adhesions Research Study. BJOG. 2000;107(7):855–62.PubMedCrossRefGoogle Scholar
  8. 8.
    Fukuhira Y, Ito M, Kakenko H, et al. Prevention of postoperative adhesions by a novel honeycomb-patterned poly(lactide) film in a rat experimental model. J Biomed Mater Res B Appl Biomater. 2008;86B:353.CrossRefGoogle Scholar
  9. 9.
    Ellis H, Moran BJ, Thompson JN, et al. Adhesion-related hospital readmissions after abdominal and pelvic surgery: a retrospective cohort study. Lancet. 1999;353(9163):1476–80.PubMedCrossRefGoogle Scholar
  10. 10.
    Parker MC, Wilson MS, Menzies D, et al. The SCAR-3 study: 5-year adhesion-related readmission risk following lower abdominal surgical procedures. Colorectal Dis. 2005;7(6):551–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Parikh JA, Ko CY, Magard MA, et al. What is the rate of small bowel obstruction after colectomy? Am Surg. 2008;74:1001–5.PubMedGoogle Scholar
  12. 12.
    van der Wal JBC, Lordens GIT, Vrijland WW, et al. Adhesion prevention during laparotomy. Ann Surg. 2011;253(6):1118–21.Google Scholar
  13. 13.
    Barmparas G, Branco BC, Schnuriger B, et al. The incidence and risk factors of post-laparotomy adhesive small bowel obstruction. J Gastrointest Surg. 2010;14:1619–28.PubMedCrossRefGoogle Scholar
  14. 14.
    Khury E, Schwenk W, Gaupset R, et al. Long-term outcome of laparoscopic surgery for colorectal cancer: a Cochrane systematic review of randomized controlled trials. Cancer Treat Rev. 2008;34:498–504.CrossRefGoogle Scholar
  15. 15.
    Liakakos T, Thomakos N, Fine P, et al. Peritoneal adhesions: etiology, pathophysiology, and clinical significance. Dig Surg. 2001;18:260–73.PubMedCrossRefGoogle Scholar
  16. 16.
    Goldberg JM, Toledo AA, Mitchell DE. An evaluation of the Gore-Tex surgical membrane for the prevention of postoperative peritoneal adhesions. Obstet Gynecol. 1987;70(6):846–8.PubMedGoogle Scholar
  17. 17.
    Duffy AJ, Hogle NJ, LaPerle KM, et al. Comparison of two composite meshes using two fixation devices in a porcine laparoscopic ventral hernia repair model. Hernia. 2004;8:358–64.PubMedCrossRefGoogle Scholar
  18. 18.
    McGinty JJ, Hogle NJ, McCarthy H, et al. A comparative study of adhesion formation and abdominal wall ingrowth after laparoscopic ventral hernia repair in a porcine model using multiple types of mesh. Surg Endosc. 2005;19(6):786–90.PubMedCrossRefGoogle Scholar
  19. 19.
    Gonzalez R, Rodeheaver GT, Moody DL, et al. Resistance to adhesion formation: a comparative study of treated and untreated mesh products placed in the abdominal cavity. Hernia. 2004;8:213–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Harrell AG, Novitsky YW, Peindl RD, et al. Prospective evaluation of adhesion formation and shrinkage of intra-abdominal prosthetics in a rabbit model. Am Surg. 2006;72(9):808–13.PubMedGoogle Scholar
  21. 21.
    Novitsky YW, Harrell AG, Cristiano JA, et al. Comparative evaluation of adhesion formation, strength of ingrowth, and textile properties of prosthetic meshes after long-term intra-abdominal implantation in a rabbit. J Surg Res. 2007;140(1):6–11.PubMedCrossRefGoogle Scholar
  22. 22.
    Jacob B, Hogle NJ, Durak E, et al. Tissue ingrowth and bowel adhesion formation in an animal comparative study: polypropylene vs. Proceed® vs. Parietex Composite®. Surg Endosc. 2007;21(4):629–33.PubMedCrossRefGoogle Scholar
  23. 23.
    Novitsky YW, Harrell AG, Hope WW, et al. Meshes in hernia repair. Surg Technol Int. 2007;16:123–7.PubMedGoogle Scholar
  24. 24.
    Gruber-Blum S, Petter-Puchner AH, Brand J, et al. Comparison of three separate antiadhesive barriers for intraperitoneal onlay mesh hernia repair in an experimental model. Br J Surg. 2010;98:442–9.PubMedCrossRefGoogle Scholar
  25. 25.
    Fortelny RH, Petter-Puchner AH, Glaser KS, et al. Adverse effects of polyvinylidene fluoride-coated polypropylene mesh used for laparoscopic intraperitoneal onlay repair of Incisional hernia. Br J Surg. 2010;97:1140–5.PubMedCrossRefGoogle Scholar
  26. 26.
    Letter 1 and Letter 2 re: Fortelny, et al. in BJS;97:1140–5. Br J Surg. 2011;98:156–60.Google Scholar
  27. 27.
    Bringman S, Conze J, Cuccurulla D, et al. Hernia repair: the search for ideal meshes. Hernia. 2010;14:81–7.PubMedCrossRefGoogle Scholar
  28. 28.
    Jenkins ED, Yom V, Melman L, et al. Prospective evaluation of adhesion characteristics to intraperitoneal mesh and adhesiolysis-related complications during laparoscopic re-exploration after prior ventral hernia repair. Surg Endosc. 2010;24:3002–7.PubMedCrossRefGoogle Scholar
  29. 29.
    Arnaud JP, Hennekinee-Mucci S, Pessaux P, et al. Ultrasound detection of visceral adhesion after intraperitoneal ventral hernia treatment: a comparative study of protected versus unprotected meshes. Hernia. 2003;7:85–8.PubMedCrossRefGoogle Scholar
  30. 30.
    Eriksen JR, Gogenur I, Rosenberg J. Choice of mesh for laparoscopic ventral hernia repair. Hernia. 2007;11:481–92.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Department of Surgery, Reemtsma Center for Innovation and Outcomes Research, College of Physicians and SurgeonsColumbia UniversityNew YorkUSA

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