Laparoscopic prosthetic ventral hernioplasty avoids the large wound required in open repairs, with attendant complications and recurrences, and appears safe, especially if an ePTFE mesh is used. Compared with conventional open ventral hernioplasty, the laparoscopic technique may also allow shorter hospitalization and a quicker return to normal activities after surgery.

Objectives: Laparoscopic ventral incisional hernia repair involves intraabdominal placement of a synthetic mesh, and the possibility of formation of severe visceral adhesions to the prosthesis is a principal concern. Little clinical information based on reoperative findings is available about adhesions to biomaterials placed intraabdominally. We conducted a multiinstitutional study of adhesions to implanted expanded polytetrafluoroethylene (ePTFE) mesh at reoperation in patients who had previously undergone laparoscopic incisional hernia repair done with the same mesh implantation technique. Methods:Nine surgeons retrospectively assessed the severity of adhesions to ePTFE mesh at reoperation in 65 patients. For each case, adhesions were assigned a score of 0 to 3, with 0 indicating no adhesions and 3 severe adhesions. Results:The mean time from mesh implantation to reoperation was 420 days (range, 2 to 1739 days). No adhesions were observed in 15 cases. Forty-four cases received an adhesion score of 1, and 6 cases a score of 2; no scores of 3 were assigned. Thus, 59 patients (91%) had either no or filmy, avascular adhesions. No enterotomies occurred during adhesiolysis. Conclusions:In this large series of reoperations after laparoscopic incisional hernia repair, no or minimal formation of adhesions to implanted ePTFE mesh was observed in 91% of cases, and no severe cohesive adhesions were found. Comparative analyses of newer mate- INTRODUCTIONThe need for reinforcement of the abdominal wall by implantation of synthetic materials during repair of abdominal incisional hernias is well established. [1][2][3][4] Moreover, because early use of various biomaterials in ventral incisional hernia repair resulted in some serious complications, including fistulization due to adhesions, 5-7 it is clear that avoiding contact between the mesh and viscera is desirable. 2,3,8,9 In laparoscopic incisional herniorrhaphy, however, first described by LeBlanc and Booth in 1993, 10 placement of the mesh in the intraabdominal position is necessary. Thus, this procedure requires a biomaterial that provides both adequate strength and a minimal risk of severe adhesion formation that could result in bowel obstruction or fistula development.Numerous studies of the formation of adhesions to biomaterials placed intraabdominally have been conducted in animals, but few investigations of this issue have been based on information obtained at reoperation in patients. Moreover, no large study has examined reoperative observations pertaining to adhesions to a biomaterial after laparoscopic incisional hernia repair specifically. Therefore, we conducted a retrospective review of findings at reoperation in patients who had undergone such a repair and in whom a 1-mm-thick expanded polytetrafluoroethylene (ePTFE) dual-surface mesh (DualMesh, W.L. Gore & Associates, Flagstaff, AZ) had been implanted during the repair. METHODS Records