gms | German Medical Science

129. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

24.04. - 27.04.2012, Berlin

Is pneumoperitoneum the cause of mesh shrinkage of biomaterial in laparoscopic IPOM hernia repair?

Meeting Abstract

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  • Nicolas Kuehnert - Universitätsklinikum Aachen, Transplantations- und Viszeralchirurgie, Aachen

Deutsche Gesellschaft für Chirurgie. 129. Kongress der Deutschen Gesellschaft für Chirurgie. Berlin, 24.-27.04.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. Doc12dgch422

doi: 10.3205/12dgch422, urn:nbn:de:0183-12dgch4227

Published: April 23, 2012

© 2012 Kuehnert.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Introduction: Today, the laparoscopic placement of intraperitoneal onlay mesh is an accepted and common technique used in hernia surgery. One of the unsolved issues of laparoscopic hernia repair is the change of volume and surface of implanted meshes after gas insufflation. The required pneumoperitoneum makes a significant increase in surface area of the abdominal wall which attracts natural post-operative mesh shrinkage after drain out the gas. This problem, caused by gas insufflation of the abdomen was estimated with a mesh visible by MRI.

Materials and methods: Laparoscopic intraperitoneal onlay mesh implantation (IPOM) was performed in 10 female rabbits using ferro-oxide loaded polyvinylidene fluoride meshes (PVDF). Intra- abdominal pressure was 9 mmHg. The change of mesh-surface was evaluated by MR-Images after 1, 30 and 90 days and expressed as percentage loss of surface of original size. The animals were killed after 90 days for comparing the MRI results with explantation measurements and furthermore random core biopsies of mesh and adjacent tissue were obtained and histological examined.

Results: The MR images showed a significant loss of mesh surface of 34.1 % directly at day 1 after laparoscopic surgery. In investigating the time between day 1 and day 90 after surgery no significant additional reduction of mesh surface was observed. Finally, the mean loss of surface was 35.4 % measured by MRI compared to 40 % of explantation measurements after the whole observation time of 90 days.

Conclusion: This study is the first experimental study which examined the effect of pneumoperitoneum in laparoscopic IPOM technique in terms of the loss of mesh surface immediately after surgery. Pneumoperitoneum in laparoscopic IPOM hernia repair seems to be responsible for a large part of the loss of mesh-surface immediately after implantation of the prosthesis, suggesting that the surgical techniques may require adjustment.