ADHESIONS AFTER LAPAROSCOPIC INGUINAL-HERNIA REPAIR - A COMPARISON OFEXTRA VERSUS INTRAPERITONEAL PLACEMENT OF A POLYPROPYLENE MESH IN AN ANIMAL-MODEL

Prosthetic mesh for laparoscopic inguinal hernia repair has become pop ular but the method of its placement is controversial. Mesh placed wit hin the peritoneum may cause adhesion formation and further complicati ons. The aim of this study was to examine the laparoscopic placement o f a mesh, comparing intraperitoneal vs extraperitoneal insertion. In a porcine model (n = 15) a polypropylene mesh was placed laparoscopical ly over the anterior abdominal wall. On the left side the mesh was sta pled on the parietal peritoneum. On the right side the peritoneum was incised, an extraperitoneal space was dissected, the mesh was inserted , and the peritoneum was closed over it. The animals were maintained f or 2 weeks. At postmortem there were adhesions in two of those placed extraperitoneally and five of those placed intraperitoneally (P = 0.19 , Fisher's exact test). The adhesions comprised fibrous peritoneal ban ds to loops of small intestine. Both methods of laparoscopic mesh plac ement were associated with a small but significant incidence of adhesi on formation.