Evaluation of intra-abdominal adhesion formation after laparoscopic ventral hernia repair with composite mesh using abdominal ultrasound: a prospective observational study


  • Jainendra K. Arora Department of General Surgery, VMMC and Safdarjung Hospital, Delhi, India
  • Manjunatha Sankal Department of General Surgery, VMMC and Safdarjung Hospital, Delhi, India
  • Rohini Gupta Ghasi Department of Radiology, VMMC and Safdarjung Hospital, Delhi, India
  • Radhika Thakur Department of Radiology, VMMC and Safdarjung Hospital, Delhi, India




Intra-abdominal adhesions, Laparoscopic ventral hernia repair, Composite mesh


Background: Laparoscopic ventral hernia repair has revolutionized treatment of ventral hernia by offering shorter recovery time, decreased pain, reduced wound complications and lower recurrence rates as compared to conventional open hernia repair. But intra-abdominal mesh placement is associated with a high risk of complications including adhesions, bowel obstruction and fistula formation. Many different types of meshes with adhesion barriers have been developed to overcome these problems. This prospective observational study evaluated the outcomes of laparoscopic repair of ventral hernias in terms of Intra-abdominal adhesion formation with composite mesh using ultrasound.

Methods: The study was conducted from August 2017 to February 2019. All patients underwent standard laparoscopic ventral hernias repair using composite mesh secured with tackers. Omentum was interposed between the mesh and underlying bowel. At a mean follow-up of one year, all patients were subjected to ultrasound examination using visceral slide technique to detect Intra-abdominal adhesions.

Results: Our study included 50 patients with a mean age of 43 years (range 26-59 years) and mean body mass index of 29.07±2.35 kg/m2 (range, 24-33 kg/m2). Mean fascial defect size of hernia was 13.4±3.77 cm2 (range12-16 cm2). There were no mesh-related complications and recurrence during the follow-up period of 1 year.

Conclusions: Laparoscopic ventral hernia repair using composite mesh seems to be a promising technique for treating ventral hernias. However, longer follow-up periods are needed to confirm effectiveness and safety of the composite mesh.


LeBlanc KA. Laparoscopic Hernia Surgery an Operative Guide, 1st ed.; CRC Press: New Orleans, LA, USA. 2003.

Usher FC, Fries JG, Ochsner JL, Tuttle LL Jr. Marlex mesh, a new plastic mesh for replacing tissue defects. II.Clinical studies. AMA Arch Surg. 1959;78(1):138-45.

Franklin ME, Dorman JP, Glass JL, Balli JE, Gonzales JJ. Laparoscopic ventral and incisional hernia repair. Surg Laparosc Endosc. 1998;8(4):294-9.

Bingener J, Kazantsev GB, Chopra S, Schwesinger WH. Adhesions formation after laparoscopic ventral Incisional hernia repair using polypropylene mesh. Journal of the society of Laparoendoscopic Surgeons. 2004;8(2):127-131.

Kodama I, Loiacona LA, Sigel B. Ultrasonic detection of visceral slide as an indicator of abdominal wall adhesions. J Clin Ultrasound. 1992;20:375-380.

Zerey M, Heniford BT. Laparoscopic versus open surgery for ventral hernia repair—which is best? Nat Clin Pract Gastroenterol Hepatol. 2006;3(7):372-3.

Morales-Conde S, Abdel-Lah A, Angoso-Catalina F, Blasco F, Feliu-Pala X, Fernandez-Lobato R, et al. Expert opinion on the basic surgical technique for laparoscopic ventral hernia repair. Cir Esp. 2005;78(4):214-21.

Perrone JM, Soper NJ, Eagon JC, Klingensmith ME, Aft RL, Frisella MM, et al. Perioperative outcomes and complications of laparoscopic ventral hernia repair. Surgery. 2005;138(4):708-15.

Moreno-Egea A, Aguayo-Albasini JL, Ballester MM, Cases Baldo´ MJ. Treatment of incisional hernias adopting an intra-abdominal approach with a new low-density composite prosthetic material: proceed: our preliminary experience on 50 cases. Surg Laparosc Endosc Percutan Tech. 2009;19(6):497-500.

Rosenberg J, Burcharth J. Feasibility and outcome after laparoscopic ventral hernia repair using Proceed mesh. Hernia. 2008;12(5):453-6.

Berrevoet F, Fierens K, De Gols J, Navez B, Van Bastelaere W, Meir E, et al. Multicentric observational cohort study evaluating a composite mesh with incorporated oxidized regenerated cellulose in laparoscopic ventral hernia repair. Hernia. 2009;13(1):23-27.






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