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

Abstract

Purpose Knowledge of postoperative behavior of mesh implants used for hernia repair is generally limited to cases of recurrence, local complications or return to the previous operative field in other pathological conditions. Previous studies with MRI-visible mesh implants in different parts of the abdominal wall have led to variable findings with regard to mesh properties and mostly described a reduction in size over time with subsequently limited mesh overlap over hernia defects which could contribute to recurrence. We aimed to evaluate implant properties in a mechanically stable anatomical region after TAPP repair of primary unilateral inguinal hernias in men with clinical and MRI examinations 4 weeks and 1 year after surgery. Methods From 11/2015 to 01/2019, 23 men with primary, unilateral, inguinal hernias underwent TAPP repair with iron particle-loaded, MRI-visible mesh implants in a prospective cohort study. In 16 patients the operative outcome could be evaluated 4 weeks and 12 months after surgery by clinical examination and MRI evaluation with regard to postoperative course, possible adverse outcomes and radiological findings related to implant behavior-namely MRI-identifiability, mesh dislocation or reduction in surface area. Results All included patients had an uneventful postoperative clinical course. MRI after 4 weeks revealed one postoperative seroma, which resolved spontaneously. No recurrence was detected. Mesh implants could be accurately delineated in DIXON-IN studies and showed neither clinically nor statistically significant changes in size or position. Conclusion 4 weeks and 1 year after a standardized TAPP procedure the mesh implant used in this study showed no tendency towards dislocation or reduction in size in this anatomical position. Its MRI visibility allows accurate delineation during the postoperative course by experienced radiologists in appropriate MRI protocols. Larger patient series are desirable to further support these findings. Shrinkage of implants in the groin as a reason for early recurrence may be overestimated.Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

X‐Ray Visible Protein Scaffolds by Bulk Iodination

“…Currently, the only commercially available contrast‐enhanced hernia mesh is a synthetic (PVDF–polyvinylidene difluoride) material, loaded with iron‐oxide nanoparticles that reduce signal intensity on MR imaging. [ 78 ] While this labeling and imaging approach increases the visibility of the implant and its shrinkage, [ 79 ] MRI is used much less frequently than CT in the clinic for hernia patients. [ 45 ] In particular, smaller bores and lower patient weight limits versus CT mean that obese patients, a significant target for mesh therapy, often cannot be imaged with MRI.…”

MRI Surveillance of Plastic Material Surgical Meshes: Experimental Model - Interim Results

“…On an MRI scan subtle modifications regarding the inflammatory response of the surrounding tissue can be detected, showing the indirect visibility of the mesh. These modifications are very weak, and they require the radiologists' close attention to the patient's history which mostly goes unnoticed [18][19][20]. Surgical meshes can be classified in groups according to their visibility in MRI.…”