Welcome to the AHS 2020 ePoster Session. Please scroll down to view all of the submitted posters or press Control-F to search. To view the poster and its abstract, click on the poster image. Many posters also have a brief audio introduction which can be played by going to the bottom of the poster screen.
P058: AN EVALUATION OF ADHESION BURDEN DURING RECURRENT VENTRAL HERNIA REPAIR
Justin D Faulkner, MD; Jordan A Bilezikian, MD; Christopher J Carballo, MD; William W Hope, MD; New Hanover Regional Medical Center
Adhesion severity after hernia repair can vary from no adhesions to dense adhesions involving viscera and/or omentum. The purpose of this study was to evaluate adhesions using a standardized scoring system in order to evaluate the range, severity and complications of adhesions following open or laparoscopic ventral hernia repair.
A retrospective analysis of patients at a single institution was performed between March 2010 and March 2020. Patients met inclusion criteria if they presented for hernia repair after a recurrence of a previously repaired ventral hernia with mesh. Adhesion burden was documented using an adhesion characteristics score (ACS) ranging from 0-4. Analysis was performed of demographics and operative findings, including ACS and adhesiolysis time, as well as perioperative complications.
Sixty-eight patients met inclusion criteria. 66% were female, 85% were Caucasian, and their average age was 58 (range 28-81). Forty-one patients (60%) underwent previous open repair, 24 (35%) underwent previous laparoscopic repair, and 3 (5%) underwent repair of unknown approach. Mesh type and mesh location (intraperitoneal or retrorectus) varied. One patient (1%) had an ACS of 0 without complication. Six patients (9%) had an ACS of 1 with a mean adhesiolysis time of 36 (+/- 24) minutes and without complication. Twenty-one patients (31%) had an ACS of 2 with a mean adhesiolysis time of 26 (+/- 12) minutes and without complication. Twenty-five patients (37%) had an ACS of 3 with a mean adhesiolysis time of 50 (+/- 27) minutes and 2 patient (3%) suffering from a single serosal tear requiring repair. Fifteen patients (22%) had an ACS of 4 with a mean adhesiolysis time of 52 (+/- 20). Three of these patients (4%) had either serosal tear(s) and/or an enterotomy related to adhesiolysis, 1 patient (1%) developed an enterocutaneous fistula related to previous mesh and 1 (1%) had a mortality secondary to a missed enterotomy during adhesiolysis. All of the patients who had complications related to adhesiolysis had undergone synthetic intraperitoneal mesh placement previously.
The greatest adhesion burden was seen in patients who underwent previous repair with intraperitoneal synthetic mesh placement. These patients suffered more intra-operative complications with one patient mortality related to adhesiolysis. The results of our study suggest that patients may benefit from avoiding intraperitoneal synthetic mesh placement. However, further study is required with a larger patient population to validate these findings.
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