Functional cine MRI of the abdomen for the assessment of implanted synthetic mesh in patients after incisional hernia repair: initial results

Abstract

The aim of our study was to develop a method that allows the visualisation and evaluation of implanted mesh in patients after incisional hernia repair with MRI. Furthermore, we assessed problems typically related with mesh implantation like adhesions and muscular atrophy. We enrolled 28 patients after incisional hernia repair. In 10 patients mesh implantation was done by laparoscopy (expanded polytetrafluoroethylene=ePTFE mesh) and in 18 by laparotomy (polypropylene mesh). Functional MRI was performed on a 1.5-T system in supine position. Sagittal and axial TrueFISP images of the entire abdomen were acquired with the patient repeatedly straining. Evaluation included: correct position and intact fixation of the mesh, furthermore visceral adhesions, recurrent hernia and atrophy of the rectus muscle. The ePTFE mesh was visible in all cases; the polypropylene mesh was not detectable. In seven of the ten ePTFE meshes the fixation was not intact; two recurrent hernias were detected. Twenty of 28 patients had intraabdominal adhesions. In 5 cases mobility of the abdominal wall was reduced, and 16 patients showed an atropy of the rectus muscle. Functional cine MRI is a suitable method for follow-up studies in patients after hernia repair. ePTFE meshes can be visualized directly, and typical complications like intestinal adhesions and abdominal wall dysmotility can be assessed reliably.

Functional cine MR imaging for the detection and mapping of intraabdominal adhesions: method and surgical correlation

“…In terms of the most common adhesion type detected, mostly adhesions between small bowel loops and the anterior abdominal wall were also reported in their study. In general, our presented results also punctuate the results published by Fischer et al [25].…”

“…Another recently published work by Fischer et al [25] studied the use of functional cine MRI for the assessment of implanted synthetic mesh after incisional hernia repair. In comparing the presented results regarding the detection and location of adhesions with their results, again the most common location of adhesions was the mid-center segments, followed by the lower center segments.…”

Detection of abdominal wall adhesions using visceral slide

“…Both noninvasive diagnostic tools have been applied to the assessment of adhesion formation to implanted intraperitoneal mesh (IPM) used in laparoscopic ventral hernia repair [24][25][26][27][28][29]. Previous validation of TAU and cine MRI showed an accuracy of 76-78% for TAU and 86% for cine MRI, which is quite similar to the data presented in the current article.…”

Adhesion formation of a polyvinylidenfluoride/polypropylene mesh for intra-abdominal placement in a rodent animal model

“…Furthermore, adhesions are reported in up to 57% of mesh area [12,13] and shrinkage was found to be almost half of the original surface area [13]. Comparable to this experimental results, within the clinical situation up to 70% of ePTFE meshes showed insufficient fixation, 80% had intra-abdominal adhesions, as well as a remarkably reduced mobility of the abdominal wall in 18% [14,15]. To further improve patient outcomes a new prosthesis was constructed.…”