Prospective cohort study on mesh shrinkage measured with MRI after laparoscopic ventral hernia repair with an intraperitoneal iron oxide-loaded PVDF mesh

Abstract

BackgroundCurrent data on shrinkage of intraperitoneal meshes come mainly from animal studies. High-quality human data in prospective studies are scarce.MethodsWe used the ability to visualize intraperitoneal PVDF meshes enhanced with iron particles (DynaMesh IPOM visible) with magnetic resonance imaging (MRI) to determine the amount of shrinkage between 1 and 13 months postoperatively. All measurements of the width, length, and surface area of the mesh were performed with a standardized methodology independently by four radiologists blinded for the timing of the MRI.ResultsOf the 15 patients undergoing laparoscopic ventral hernia repair, 13 patients received an MRI both at 1 and at 13 months. Evaluation of inter-rater reliability between the radiologists showed intra-class correlations of 0.95 (95% CI 0.92–0.98) for the width, 0.96 (95% CI 0.93–0.98) for the length, and 0.99 (90% CI 0.99–1.00) for the surface area of the mesh. The change between measurement at implantation and 1-month MRI was − 0.7 cm (P = 0.023; − 3.6%) for the width and − 1.9 cm (P = 0.001; − 7.2%) for the length. The change between 1 and 13 months was − 0.06 cm (P = 0.74; shrinkage = 0.3%) for the width, − 0.12 cm (P = 0.56; shrinkage = 0.5%) for the length, and − 4.0 cm2 (P = 0.20; shrinkage = 1.0%) for the surface area of the mesh.ConclusionThere is excellent inter-rater reliability between radiologists when measuring width, length, and surface area of visible intraperitoneal PVDF mesh with MRI. There is no significant shrinkage between 1 and 13 months of intraperitoneal PVDF mesh after laparoscopic ventral hernia repair.

Surgical and radiological behavior of MRI-depictable mesh implants after TAPP repair: the IRONMAN study

“…Yet, comparability of the published studies is limited by various factors: First, early experimental trials were carried out in agarose phantoms [1] or small animals [2] rather than in human patients. Second, implant materials are heterogeneous in the available literature [3,4,9]. Even after reduction of mesh materials to iron-loaded PVDF implants, differences in results are found due to their use in the repair of different types of hernias: results for primary, incisional, ventral, inguinal, parastomal, and diaphragmatic hernias are published.…”

“…Even after reduction of mesh materials to iron-loaded PVDF implants, differences in results are found due to their use in the repair of different types of hernias: results for primary, incisional, ventral, inguinal, parastomal, and diaphragmatic hernias are published. Authors used various types of mesh fixation including fibrin glue [6], interrupted [12] or continuous [3] sutures, as well as absorbable [4] and non-absorbable [9] tackers. In addition, implants were placed in a variety of positions relative to the layers of the abdominal wall: results for Lichtenstein, TAPP, laparoscopic or open IPOM, sublay, inlay and onlay repair are available.…”

“…In the end outcomes were evaluated at a wide range of points in time, depending on the different study designs: several publications include immediate postoperative findings [1,2] and compare them to implant properties prior to implantation [5] or to findings at varying postoperative set-points. Follow-up times range from 2 [3] to mostly 90 [1,5,6,8] days with two longer observational periods of 6 and 13 months [4,12]. The number of implants is generally small or very small with a median of 9 (range 2-124) and often evaluates results in both men and women [4,6,10].…”

“…Follow-up times range from 2 [3] to mostly 90 [1,5,6,8] days with two longer observational periods of 6 and 13 months [4,12]. The number of implants is generally small or very small with a median of 9 (range 2-124) and often evaluates results in both men and women [4,6,10]. Gender may not be a very important factor in other types of hernias but due to anatomical differences it could certainly influence the outcome in inguinal hernias.…”

“…Two studies [1,3] focused on inguinal hernias. All trials to date include a limited number of patients and evaluate in vivo mesh behavior in very different anatomical positions [1,[3][4][5][6]. In addition, postoperative mesh size and surface were usually analyzed at different points in time.…”