Adverse Events, Quality of Life, and Recurrence Rates after Laparoscopic Adhesiolysis and Recurrent Incisional Hernia Mesh Repair in Patients with Previous Failed Repairs

BACKGROUND: The aim of this study was to determine the impact of laparoscopic adhesiolysis and mesh repair on adverse event rates, quality-of-life (QoL) scores, and recurrence rates in patients with recurrent incisional hernia after failed repairs after multiple laparotomies. STUDY DESIGN: Data on consecutive patients were included prospectively. Recurrent incisional hernia was defined as a fascia defect > 5 cm. Adhesions were classified according to time needed for lysis. A standardized repair with IP polytetrafluoroethylene mesh, transabdominal sutures, and tacks was developed by the surgeons during a pretrial routine. QoL was assessed by the Gastrointestinal Quality of Life Index (GIQLI) before operation and at 24-month followup. Values are median (range). RESULTS: There were 85 consecutive patients aged 55 years (range 29 to 93 years); 45% were men; body mass index, 31 (range 23 to 39); American Society of Anesthesiologists grade 1: 27%, 11: 70%, III: 2%; comorbidity, 75%; previous laparotomies; 5 (range 2 to 18); previous colectomy, 87%; previous failed repairs, 4 (range 2 to 15); previous mesh repair, 98%; and midline hernia site, 98%. Fascia defect was 255 cm(2) (range 48 to 416 cm(2)), mesh size, 600 cm(2) (range 285 to 884 cm(2)), and operating time 145 minutes (80 to 210 minutes). There was one conversion. Length of stay was 2 days (I to 9 days). A 15.2% adverse event rate included 1% port-site cellulitis, 7% seroma, and 7% persistent pain. Hernia recurrence rate was 3.5% at 41-month (range 24 to 61 months) followup. GIQLI total scores were significantly improved at followup (98 versus 116; p < 0.001). Domain GIQLI scores were improved at followup, for symptoms (54 versus 63; p < 0.001), emotional function (12 versus 16; p < 0.001), and physical function (15 versus 21; p < 0.001). CONCLUSIONS: Laparoscopic adhesiolysis and recurrent hernia mesh repair resulted in a low rate of adverse events, a substantially improved health-related QoL, and a risk of recurrence similar to the rates associated with first-time hernia repair. (J Am Coll Surg 2008;207:663-669. (C) 2008 by the American College of Surgeons)