Follow Up Data of MRI-Visible Synthetic Meshes for Reinforcement in Large Hiatal Hernia in Comparison to None-Mesh Repair—A Prospective Cohort Study

Weyhe, Dirk; Klinge, U.; Uslar, Verena; Tabriz, Navid

doi:10.3389/fsurg.2019.00017

Cited by 5 publications

(3 citation statements)

References 31 publications

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“…The reduction in mesh hiatoplasty did not result in less favorable outcomes (30). Magnetic resonance imaging of visible meshes can be used in future to demonstrate mesh shrinkage or potential complications (31).…”

Section: Discussionmentioning

confidence: 99%

What Is the Reality of Hiatal Hernia Management?—A Registry Analysis

et al. 2020

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Introduction: To date, the guidelines for surgical repair of hiatal hernias do not contain any clear recommendations on the hiatoplasty technique with regard to the use of a mesh or to the type of fundoplication (Nissen vs. Toupet). This present 10-years analysis of data from the Herniamed Registry aims to investigate these questions. Methods: Data on 17,328 elective hiatal hernia repairs were entered into the Herniamed Registry between 01.01.2010 and 31.12.2019. 96.4% of all repairs were completed by laparoscopic technique. One-year follow-up was available for 11,280 of 13,859 (81.4%) patients operated during the years 2010-2018. The explorative Fisher's exact test was used for statistical calculation of significant differences with an alpha = 5%. Since the annual number of cases in the Herniamed Registry in the years 2010-2012 was still relatively low, to identify significant differences the years 2013 and 2019 were compared Results: The use of mesh hiatoplasty for axial and recurrent hiatal hernias remained stable over the years from 2013 to 2019 at 20 and 45%, respectively. In the same period the use of mesh hiatoplasty for paraesophageal hiatal hernia slightly, but significantly, increased from 33.0 to 38.9%. The proportion of Nissen and Toupet fundoplications for axial hiatal hernia repair dropped from 90.2% in 2013 to 74.0% in 2019 in favor of "other techniques" at 20.9%. For the paraesophageal hiatal hernias (types II-IV) the proportion of Nissen and Toupet fundoplications was 68.1% in 2013 and 66.0% in 2019. The paraesophageal hiatal hernia repairs included a proportion of gastropexy procedures of 21.7% in 2013 and 18.7% in 2019. The recurrent hiatal hernia repairs also included a proportion of gastropexies 12.8% in 2013 and 15.1% in 2019, Nissen and Toupet fundoplications of 72.7 and 62.7%, respectively, and "other techniques" of 14.5 and 22.2%, respectively. No changes were seen in the postoperative complication and recurrence rates. Conclusion: Clear trends are seen in hiatal hernia repair. The use of meshes has only slightly increased in paraesophageal hiatal hernia repairs. The use of alternative techniques has resulted in a reduction in the use of the "classic" Nissen and Toupet fundoplication surgical techniques.

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Section: Discussionmentioning

confidence: 99%

What Is the Reality of Hiatal Hernia Management?—A Registry Analysis

et al. 2020

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“…MRI is not the common method in clinical practice to monitor mesh outcome even though this method is reported in some preclinical or clinical researches [10,12,16,17] and present the major advantage to provide the ability for long term follow up of the same individual in a non-invasive manner.…”

Section: Discussionmentioning

confidence: 99%

“…The major limitation of MRI to image intraabdominal meshes is linked to the thinness of the polymeric mesh filaments and their short signal relaxation times T2 that make them appear usually as dark fine lines or spots on the T2-weighted MR images. This characteristic was even reinforced with the association of iron oxide nanoparticles within the filament [17][18][19]. However, this type of contrast enhancement can also be jeopardized by the normal post-surgical evolutions or complications such as seroma, local inflammation, or foreign body reaction[3].…”

Section: Discussionmentioning

confidence: 99%

Can magnetisation transfer magnetic resonance imaging help for the follow-up of synthetic hernia composite meshes fate? A pilot study

Franconi

Lefranc

Radlovic

et al. 2022

Magn Reson Mater Phy

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Purpose:This study aims at evaluating the non-invasive Magnetic Resonance Imaging (MRI) technic to visualize a synthetic composite hernia mesh using a rodent model and to document the integration of this device over 4 months. Methods:Uncoated polyethylene terephthalate mesh and synthetic composite mesh-faced on the visceral side with a chemically engineered layer of copolymer of glycolide, caprolactone, trimethylene carbonate, and lactide to minimize tissue attachment-were placed intraperitoneally in rats, facing the caecum previously scraped to promote petechial bleeding and subsequent adhesions. Meshes fate follow-up was performed 4, 10, and 16-weeks post-implantation using a rodent dedicated high field MRI. Magnetization transfer (MT) images were acquired, associated with pneumoperitonealMRI performed after intraperitoneal injection of 8 mL gas to induce mechanical stress on the abdominal wall. Results:Uncoated meshes were clearly visible using both T2-weighted and MT imaging during the whole study while composite meshes conspicuity was not so evident on T2-weighted MRI and could be improved using MT imaging. Adhesions and collagen infiltration were massive for the uncoated meshes as expected. On the contrary, composite meshes showed very limited adhesion, and, if any, occurring at the edge of the mesh, starting at the fixation points. Conclusions:Magnetization transfer imaging allows to detect mesh integration and, associated with pneumoperitoneum, was able to probe the effective minimizing effect of the synthetic polymeric barrier on visceral attachments. However, magnetization transfer imaging could not unambiguously allow the visualization of the mesh through the polymeric barrier.

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Clinical and computed tomography outcomes after mesh‐enforced hiatoplasty and anterior hemi‐fundoplication in large hiatal hernia repair

Süsstrunk,

Stimpfle,

Wilhelm

et al. 2024

World j. surg.

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BackgroundThe surgical technique in large hiatal hernia (HH) repair is controversially discussed and the outcome measures and follow‐up schemes are highly heterogeneous. The aim of this study is to assess the true recurrence rate using computed tomography (CT) in patients with standardized large HH repair.MethodsProspective single‐center study investigating the outcome after dorsal, mesh‐enforced large HH repair with anterior fundoplication. Endoscopy was performed after 3 months and clinical follow‐up and CT after 12 months.ResultsBetween 2012 and 2021, 100 consecutive patients with large HH were operated in the same technique. There were two reoperations within the first 90 days for cephalad migration of the fundoplication. Endoscopic follow‐up showed a correct position of the fundoplication and no relevant other pathologies in 99% of patients. Follow‐up CT was performed in 100% of patients and revealed 6% of patients with a cephalad slippage, defined as migration of less than 3 cm of the wrap, and 7% of patients with a recurrent hernia. One patient of each group underwent subsequent reoperation due to symptoms. There was no statistical correlation between abnormal radiological findings and clinical outcomes with 69.2% of patients being asymptomatic. Multivariate logistic regression did not show any prognostic factor for an unfavorable radiologic outcome. Ninety‐four percent of patients rated their outcomes as excellent or good.ConclusionRadiological follow‐up after large HH repair using CT allows to detect slippage of the fundoplication wrap and small recurrences. Patients with unfavorable radiological outcomes rarely require operative revision but should be considered for further follow‐up.

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Follow Up Data of MRI-Visible Synthetic Meshes for Reinforcement in Large Hiatal Hernia in Comparison to None-Mesh Repair—A Prospective Cohort Study

Cited by 5 publications

References 31 publications

What Is the Reality of Hiatal Hernia Management?—A Registry Analysis

What Is the Reality of Hiatal Hernia Management?—A Registry Analysis

Can magnetisation transfer magnetic resonance imaging help for the follow-up of synthetic hernia composite meshes fate? A pilot study

Clinical and computed tomography outcomes after mesh‐enforced hiatoplasty and anterior hemi‐fundoplication in large hiatal hernia repair

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