Factors increasing the risk of adhesion formation after intraperitoneal onlay mesh hernia repair

To identify factors influencing adhesion formation in patients with primary ventral hernias after intraperitoneal onlay mesh (IPOM) hernia repair. Intraperitoneal repair was performed in patients with primary ventral hernias using either an open (n=10) or laparoscopic (n=33) approach. Peritoneal adhesion was diagnosed using ultrasound in the overall group (n = 43) 12 months after surgery. The influence of demographic parameters, patient health indicators, parameters associated with the presence of a hernia, intraoperative parameters, parameters associated with the mesh and fixation method, postoperative parameters, and parameters for assessing the safety of surgical intervention on adhesion formation was assessed. A multivariate analysis conducted 12 months after surgery revealed no statistically significant impact of demographic parameters and patient health indicators on adhesion formation. Of all the parameters associated with the presence of a hernia, only the size of the hernial defect (p = 0.008) and the total area of the hernial orifice (p = 0.043) had a significant impact on the severity of adhesion formation. Adhesions in the mesh area increased with increasing these parameters. A similar effect was observed with increasing mesh size (p = 0.046). Of the remaining parameters studied, only the presence of adhesions before surgery (p = 0.037) and late postoperative complications (p = 0.005) significantly increased adhesion formation. The study showed that parameters that statistically significantly increase adhesion formation in the mesh area after IPOM hernioplasty include the size of the primary hernia, the area of the hernial orifice and mesh, adhesions outside the mesh area before surgery, and the presence of late postoperative complications. Most of these parameters are independent. The exception is mesh size, which is directly related to the area of the hernial orifice.