Functional cine MRI and transabdominal ultrasonography for the assessment of adhesions to implanted synthetic mesh 5-7 years after laparoscopic ventral hernia repair

TY - JOUR

T1 - Functional cine MRI and transabdominal ultrasonography for the assessment of adhesions to implanted synthetic mesh 5-7 years after laparoscopic ventral hernia repair

AU - Zinther, N B

AU - Zeuten, A

AU - Marinovskij, E

AU - Haislund, M

AU - Friis-Andersen, H

PY - 2010/10

Y1 - 2010/10

N2 - BACKGROUND: Laparoscopic ventral hernia repair (LVHR) has gained worldwide acceptance, due to its minimally invasive character, feasibility and low rate of complications. Animal experiments have shown marked adhesions to the intraperitoneal mesh (IPM), the clinical consequences being unclear. This study aimed to describe the extension of adhesions to the mesh, 5-7 years after LVHR, using two validated non-invasive radiologic methods.METHODS: Real-time transabdominal ultrasonography (TAU) and cine magnetic resonance imaging (MRI) was applied to 30 patients with prior LVHR and implantation of IPM (Intramesh W3, Cousin Biotech, France). The visceral slide was measured in nine predefined abdominal segments. Values RESULTS: The mean time between LVHR and TAU/cine MRI was 67 months (range, 58-80 months). We found adhesion to the mesh in 90% of the patients using TAU and 100% of the patients using cine MRI. In the latter, 65% were between the bowel and IPM.CONCLUSIONS: LVHR is known to reduce recurrences and postoperative complications, while improving patient outcome. The intraperitoneal placement of the mesh has been shown to induce adhesions; the amount and extension in the clinical setting is unclear. The present study showed a marked proportion of adhesions to the mesh with an average surgery to scan time of 5.6 years, despite an anti-adhesive barrier on the visceral surface of the mesh. Together with existing data, this result increases the concern related to the long-term consequences of an IPM. As a consequence, a comprehensive and comparable test system for medical devices, i.e. IPM, is needed.

AB - BACKGROUND: Laparoscopic ventral hernia repair (LVHR) has gained worldwide acceptance, due to its minimally invasive character, feasibility and low rate of complications. Animal experiments have shown marked adhesions to the intraperitoneal mesh (IPM), the clinical consequences being unclear. This study aimed to describe the extension of adhesions to the mesh, 5-7 years after LVHR, using two validated non-invasive radiologic methods.METHODS: Real-time transabdominal ultrasonography (TAU) and cine magnetic resonance imaging (MRI) was applied to 30 patients with prior LVHR and implantation of IPM (Intramesh W3, Cousin Biotech, France). The visceral slide was measured in nine predefined abdominal segments. Values RESULTS: The mean time between LVHR and TAU/cine MRI was 67 months (range, 58-80 months). We found adhesion to the mesh in 90% of the patients using TAU and 100% of the patients using cine MRI. In the latter, 65% were between the bowel and IPM.CONCLUSIONS: LVHR is known to reduce recurrences and postoperative complications, while improving patient outcome. The intraperitoneal placement of the mesh has been shown to induce adhesions; the amount and extension in the clinical setting is unclear. The present study showed a marked proportion of adhesions to the mesh with an average surgery to scan time of 5.6 years, despite an anti-adhesive barrier on the visceral surface of the mesh. Together with existing data, this result increases the concern related to the long-term consequences of an IPM. As a consequence, a comprehensive and comparable test system for medical devices, i.e. IPM, is needed.

KW - Abdomen/diagnostic imaging

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Diagnosis, Differential

KW - Female

KW - Follow-Up Studies

KW - Hernia, Ventral/surgery

KW - Humans

KW - Laparoscopy/methods

KW - Magnetic Resonance Imaging, Cine/methods

KW - Male

KW - Middle Aged

KW - Polytetrafluoroethylene/adverse effects

KW - Retrospective Studies

KW - Surgical Mesh/adverse effects

KW - Tissue Adhesions/diagnosis

KW - Ultrasonography

U2 - 10.1007/s10029-010-0676-x

DO - 10.1007/s10029-010-0676-x

M3 - Journal article

C2 - 20490585

SN - 1265-4906

VL - 14

SP - 499

EP - 504

JO - Hernia

JF - Hernia

IS - 5

ER -