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Lorenz R, Vollmer U, Conze J, Loch F, Paul-Promchan K, Mantke R, Paasch C, Wiessner R. Is there a link between Spigelian and inguinal hernias? A case series. Hernia 2024:10.1007/s10029-024-03061-5. [PMID: 38935190 DOI: 10.1007/s10029-024-03061-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 04/24/2024] [Indexed: 06/28/2024]
Abstract
INTRODUCTION Spigelian hernias are among the rare primary ventral hernias. Diagnosis is often difficult, as many cases are asymptomatic. Spigelian and inguinal hernias are usually considered separately in current scientific literature. With this case series, we want to illustrate a possible relationship between the neighboring hernia types. METHODS In this article, we report on a case series of Spigelian hernias that were operated on in five hernia centers in the period from January 1st, 2021 to October 31st, 2023. We have summarized all patient characteristics with previous operations and the result of the secondary operation. RESULTS We report a case series with 24 Spigelian hernias, 15 of which have a connection to previous inguinal hernias. In these cases, however, it is not certain whether these are primarily overlooked or occult hernias or whether these Spigelian hernias have arisen secondarily, as a result of previous hernia surgery. With this case series, we would like to point out a possible connection between Spigelian hernia and inguinal hernia. Further studies are needed to shed more light on this entity and explain its genesis.
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Affiliation(s)
- R Lorenz
- Hernia Center, 3+CHIRURGEN, Klosterstrasse 34/35, 13581, Berlin, Germany.
- Department of General and Abdominal Surgery, Clinic for General and Abdominal Surgery, Medical University Brandenburg an Der Havel, Fehrbelliner Strasse 38, 3+CHIRURGEN, Klosterstrasse 34/35, 13581, Berlin, Germany.
- Havelklinik Berlin, 3+CHIRURGEN, Klosterstrasse 34/35, 13581, Berlin, Germany.
| | - U Vollmer
- Park-Klinik Weißensee, Department of General Surgery, Schönstrasse 80, 13086, Berlin, Germany
| | - J Conze
- UM Hernienzentrum Dr. Conze, Arabellastraße 17, 81925, Munich, Germany
| | - F Loch
- Department of Surgery, Charité-Universitätsmedizin Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - K Paul-Promchan
- Department of General Surgery, Hospital Bethel Berlin, Promenadenstrasse 3-5, 12207, Berlin, Germany
| | - R Mantke
- Department of General and Abdominal Surgery, Clinic for General and Abdominal Surgery, Medical University Brandenburg an Der Havel, Fehrbelliner Strasse 38, 3+CHIRURGEN, Klosterstrasse 34/35, 13581, Berlin, Germany
- Faculty of Medicine, Brandenburg Medical School Thedor Fontane, Brandenburg, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an Der Havel, Germany
| | - C Paasch
- Department of General and Abdominal Surgery, Clinic for General and Abdominal Surgery, Medical University Brandenburg an Der Havel, Fehrbelliner Strasse 38, 3+CHIRURGEN, Klosterstrasse 34/35, 13581, Berlin, Germany
| | - R Wiessner
- Bodden-Klinik Ribnitz-Damgarten, Sandhufe 2, 18311, Ribnitz-Damgarten, Germany
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Rodicio Miravalles JL, Méndez CSM, Lopez-Monclus J, Moreno Gijón M, López Quindós P, Amoza Pais S, López López A, García Bear I, Menendez de Llano Ortega R, Díez Pérez de Las Vacas MI, Garcia-Urena MA. Short-term outcomes of a multicentre prospective study using a "visible" polyvinylidene fluoride onlay mesh for the prevention of midline incisional hernia. Langenbecks Arch Surg 2024; 409:136. [PMID: 38652308 DOI: 10.1007/s00423-024-03307-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 04/03/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Prophylactic meshes in high-risk patients prevent incisional hernias, although there are still some concerns about the best layer to place them in, the type of fixation, the mesh material, the significance of the level of contamination, and surgical complications. We aimed to provide answers to these questions and information about how the implanted material behaves based on its visibility under magnetic resonance imaging (MRI). METHOD This is a prospective multicentre observational cohort study. Preliminary results from the first 3 months are presented. We included general surgical patients who had at least two risk factors for developing an incisional hernia. Multivariate logistic regression was used. A polyvinylidene fluoride (PVDF) mesh loaded with iron particles was used in an onlay position. MRIs were performed 6 weeks after treatment. RESULTS Between July 2016 and June 2022, 185 patients were enrolled in the study. Surgery was emergent in 30.3% of cases, contaminated in 10.7% and dirty in 11.8%. A total of 5.6% of cases had postoperative wound infections, with the requirement of stoma being the only significant risk factor (OR = 7.59, p = 0.03). The formation of a seroma at 6 weeks detected by MRI, was associated with body mass index (OR = 1.13, p = 0.02). CONCLUSIONS The prophylactic use of onlay PVDF mesh in midline laparotomies in high-risk patients was safe and effective in the short term, regardless of the type of surgery or the level of contamination. MRI allowed us to detect asymptomatic seromas during the early process of integration. STUDY REGISTRATION This protocol was registered at ClinicalTrials.gov (NCT03105895).
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Affiliation(s)
- José Luis Rodicio Miravalles
- Division of General Surgery, Hospital Universitario Central de Asturias (HUCA), Avda de Roma, s/n, Oviedo, Asturias, 33011, Spain.
| | - Carlos San Miguel Méndez
- Division of General Surgery, Grupo de Investigación de Pared Abdominal Compleja, Universidad Francisco de Vitoria, Hospital Universitario del Henares, Madrid, Spain
| | - Javier Lopez-Monclus
- Division of General Surgery, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - María Moreno Gijón
- Division of General Surgery, Hospital Universitario Central de Asturias (HUCA), Avda de Roma, s/n, Oviedo, Asturias, 33011, Spain
| | - Patricia López Quindós
- Division of General Surgery, Grupo de Investigación de Pared Abdominal Compleja, Universidad Francisco de Vitoria, Hospital Universitario del Henares, Madrid, Spain
| | - Sonia Amoza Pais
- Division of General Surgery, Hospital Universitario Central de Asturias (HUCA), Avda de Roma, s/n, Oviedo, Asturias, 33011, Spain
| | - Antonio López López
- Division of General Surgery, Hospital Universitario Nuestra Señora del Prado, Toledo, Spain
| | - Isabel García Bear
- Division of General Surgery, Hospital Universitario San Agustin, Avilés, Spain
| | | | | | - Miguel Angel Garcia-Urena
- Division of General Surgery, Grupo de Investigación de Pared Abdominal Compleja, Universidad Francisco de Vitoria, Hospital Universitario del Henares, Madrid, Spain
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Khader R, Whitehead-Clarke T, Mudera V, Kureshi A. Assessment of mesh shrinkage using fibroblast-populated collagen matrices: a proof of concept for in vitro hernia mesh testing. Hernia 2024; 28:495-505. [PMID: 38180627 PMCID: PMC10997730 DOI: 10.1007/s10029-023-02941-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 12/07/2023] [Indexed: 01/06/2024]
Abstract
PURPOSE This study uses free-floating contractile fibroblast-populated collagen matrices (FPCMs) to test the shrinkage of different hernia mesh products. We hope to present this model as a proof of concept for the development of in vitro hernia mesh testing-a novel technology with interesting potential. METHODS FPCMs were formed by seeding Human Dermal Fibroblasts into collagen gels. FPCMs were seeded with three different cell densities and cast at a volume of 500 μl into 24-well plates. Five different mesh products were embedded within the collagen constructs. Gels were left to float freely within culture media and contract over 5 days. Photographs were taken daily and the area of the collagen gel and mesh were measured. Media samples were taken at days 2 and 4 for the purposes of measuring MMP-9 release. After 5 days, dehydrated FPCMs were also examined under light and fluorescence microscopy to assess cell morphology. RESULTS Two mesh products-the mosquito net and large pore lightweight mesh were found to shrink notably more than others. This pattern persisted across all three cell densities. There were no appreciable differences observed in MMP-9 release between products. CONCLUSIONS This study has successfully demonstrated that commercial mesh products can be successfully integrated into free-floating contractile FPCMs. Not only this, but FPCMs are capable of applying a contractile force upon those mesh products-eliciting different levels of contraction between mesh products. Such findings demonstrate this technique as a useful proof of concept for future development of in vitro hernia mesh testing.
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Affiliation(s)
- R Khader
- Centre for 3D Models of Health and Disease, Division of Surgery & Interventional Science, University College London, London, UK
| | - T Whitehead-Clarke
- Centre for 3D Models of Health and Disease, Division of Surgery & Interventional Science, University College London, London, UK.
| | - V Mudera
- Centre for 3D Models of Health and Disease, Division of Surgery & Interventional Science, University College London, London, UK
| | - A Kureshi
- Centre for 3D Models of Health and Disease, Division of Surgery & Interventional Science, University College London, London, UK
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Mesh shrinkage after transabdominal preperitoneal inguinal hernia repair. Sci Rep 2023; 13:3894. [PMID: 36890203 PMCID: PMC9995439 DOI: 10.1038/s41598-023-31088-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 03/06/2023] [Indexed: 03/10/2023] Open
Abstract
Synthetic mesh is now used for inguinal hernia repair in most cases. It is well known that the indwelling mesh contracts after placement in the body, regardless of the material. The aim of this study was to develop a method for indirect measurement of the mesh area postoperatively that allows for easy comparison with the condition of the mesh immediately after surgery. X-ray-impermeable tackers were used to fix the mesh, and changes of the indwelling mesh after surgery were measured indirectly using two mesh materials. This study involved 26 patients who underwent inguinal hernia repair with a polypropylene or polyester mesh (13 patients each). Polypropylene showed a stronger tendency to shrink, but there was no significant difference between the materials. For both materials, some patients showed relatively strong shrinkage and others showed relatively weak shrinkage. The group with the strong shrinkage had significantly higher body mass index. The results of the present study showed that mesh surly shrinked over time and there was no adverse effect of mesh shrinkage on the patients outcomes in this population. Mesh would shrink over time regardless of the sort of mesh but it did not affect the patients outcomes.
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Vierstraete M, Beckers R, Vangeel L, Foriers B, Pletinckx P, Muysoms F. Prospective cohort study on mesh shrinkage measured with MRI after robot-assisted minimal invasive retrorectus ventral hernia repair using an iron-oxide-loaded polyvinylidene fluoride mesh. Surg Endosc 2023:10.1007/s00464-023-09938-3. [PMID: 36854798 DOI: 10.1007/s00464-023-09938-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 02/05/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND Mesh-reinforced ventral hernia repair is considered the gold standard treatment for all but the smallest of hernias. Human data on mesh shrinkage in the retrorectus mesh position is lacking. A prospective observational cohort study was performed to measure mesh shrinkage in robot-assisted minimal invasive retrorectus repair of ventral hernias. METHODS A cohort of 20 patients underwent a robot-assisted minimal invasive retrorectus repair of their ventral hernia. Magnetic resonance imaging (MRI) imaging was performed one month and thirteen months after implantation of an iron-oxide-impregnated polyvinylidene fluoride (PVDF) mesh to assess the decrease in mesh surface area. Inter-rater reliability among three radiologists regarding measurement of the mesh dimensions was analyzed. Quality of Life scoring was evaluated. RESULTS The inter-rater reliability between the radiologists reported as the intra-class correlations proved to be excellent for mesh width (ICC 0.95), length (ICC 0.98) and surface area (ICC 0.99). Between MRI measurements at one month and thirteen months postoperatively, there was a significant increase in mesh surface area (+ 12.0 cm2, p = 0.0013) and mesh width (+ 0.8 cm, p < 0.001), while the length of the mesh remained unchanged (-0.1 cm, p = 0.754). Quality of Life Scoring showed a significant improvement in Quality of Life after one month and a further improvement at thirteen months (p < 0.001). CONCLUSION There was an excellent inter-rater reliability between three radiologists when measuring width, length, and surface area of an iron-oxide-impregnated PVDF mesh using MRI visualization. Mesh shrinkage was not observed, instead the effective mesh surface area and width of the mesh increased.
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Affiliation(s)
- Maaike Vierstraete
- Department of Surgery, Maria Middelares Hospital, Buitenring Sint-Denijs 30, 9000, Ghent, Belgium.
| | - Roel Beckers
- Department of Radiology, Maria Middelares Hospital, Buitenring Sint-Denijs 30, 9000, Ghent, Belgium
| | - Lorenz Vangeel
- Department of Radiology, Maria Middelares Hospital, Buitenring Sint-Denijs 30, 9000, Ghent, Belgium
| | - Brend Foriers
- Department of Radiology, Maria Middelares Hospital, Buitenring Sint-Denijs 30, 9000, Ghent, Belgium
| | - Pieter Pletinckx
- Department of Surgery, Maria Middelares Hospital, Buitenring Sint-Denijs 30, 9000, Ghent, Belgium
| | - Filip Muysoms
- Department of Surgery, Maria Middelares Hospital, Buitenring Sint-Denijs 30, 9000, Ghent, Belgium
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Amato G, Agrusa A, Puleio R, Micci G, Cassata G, Cicero L, Di Buono G, Calò PG, Galia M, Romano G. A regenerative 3D scaffold for inguinal hernia repair. MR imaging and histological cross evidence. Qualitative study. Int J Surg 2021; 96:106170. [PMID: 34775110 DOI: 10.1016/j.ijsu.2021.106170] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 09/08/2021] [Accepted: 11/03/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Inguinal hernia is a degenerative disease occurring in a high motile surround. Stopping degeneration and promoting tissue regeneration should be the treatment goal. Groin hernias are conventionally managed with static flat meshes, mostly fixated to the delicate inguinal environment. Far from a regenerative effect, the biologic response of conventional hernia meshes is characterized by a foreign body reaction leading to a stiff/shrunken scar plate, which is often the source of unpleasant complications. Recently, a newly engineered 3D device for inguinal hernia repair - ProFlor-has been developed to produce a regenerative biological response. Unlike conventional hernia meshes, this regenerative 3D hernia scaffold seems to demonstrate suitable features for a pathogenetical and physiological coherent treatment of the disease. The aim of this manuscript is to cross evidence these features through magnetic resonance imaging (MRI) and histology. STUDY DESIGN The biological response of ProFlor at three defined post-implantation stages has been evaluated through MRI signal intensity and compared to neighbouring muscles and fat. As additional proof, histology of tissue specimens excised at the same post-implantation periods from porcine models during an experimental attempt were also evaluated. RESULTS MRI of newly ingrown tissue in ProFlor demonstrated similar signal intensity of muscles while fat tissue showed remarkably higher values. These data matched with the histology of ProFlor biopsies excised from pigs. CONCLUSIONS The motile compliance to groin movements of ProFlor appears to induce a probiotic biologic response comparable to a regenerative scaffold, allowing to physiologically resolve the degenerative source of inguinal hernia disease.
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Affiliation(s)
- Giuseppe Amato
- Postgraduate School of General Surgery, University of Cagliari, Italy Department of General Surgery and Emergency, University of Palermo, Italy Experimental Zooprophylactic Institute A. Mirri, Palermo, Italy Department of Biomedicine, Neurosciences and Advanced Diagnostic University of Palermo, Italy Department of Surgical Sciences, University of Cagliari, Italy
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Azimov RK, Al-Ariki M, Akhmedov TZ, Tarxani M. [Titanium mesh implants in herniology]. Khirurgiia (Mosk) 2019:126-131. [PMID: 31825353 DOI: 10.17116/hirurgia2019121126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Literature review is devoted to the main implants used in hernia surgery and their disadvantages. Advisability of titanium mesh implants in surgery of anterior abdominal wall hernias is shown.
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Affiliation(s)
- R Kh Azimov
- The Department of hospital surgery with the course of pediatric surgery of the RUDN University, Moscow, Russia
| | - M Al-Ariki
- Central Clinical Hospital of the Russian Academy of Sciences, Moscow, Russia
| | - T Z Akhmedov
- Central Clinical Hospital of the Russian Academy of Sciences, Moscow, Russia
| | - M Tarxani
- Central Clinical Hospital of the Russian Academy of Sciences, Moscow, Russia
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Lechner M, Meissnitzer M, Borhanian K, Bittner R, Kaufmann R, Mayer F, Jäger T, Mitterwallner S, Emmanuel K, Forstner R. Surgical and radiological behavior of MRI-depictable mesh implants after TAPP repair: the IRONMAN study. Hernia 2019; 23:1133-1140. [PMID: 31367964 PMCID: PMC6938468 DOI: 10.1007/s10029-019-02019-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 07/20/2019] [Indexed: 10/29/2022]
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.
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Affiliation(s)
- M Lechner
- Department of Surgery, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria.
| | - M Meissnitzer
- Department of Radiology, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - K Borhanian
- Department of Surgery, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - R Bittner
- Department of Surgery, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - R Kaufmann
- Department of Radiology, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - F Mayer
- Department of Surgery, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - T Jäger
- Department of Surgery, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - S Mitterwallner
- Department of Surgery, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - K Emmanuel
- Department of Surgery, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - R Forstner
- Department of Radiology, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
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A prospective pilot study on MRI visibility of iron oxide-impregnated polyvinylidene fluoride mesh after ventral rectopexy. Tech Coloproctol 2019; 23:633-637. [PMID: 31270653 PMCID: PMC6692291 DOI: 10.1007/s10151-019-02022-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 06/20/2019] [Indexed: 12/12/2022]
Abstract
Background Magnetic resonance imaging (MRI) provides excellent information about pelvic anatomy after ventral rectopexy, but the position of the conventional mesh is not seen constantly. Iron oxide-impregnated polyvinylidene fluoride (PVDF) meshes are proven to have MRI visibility in hernia or vaginal reconstructive surgery. This prospective pilot study was designed to assess the visualization, position, and shape of the magnetic resonance (MR)–visible synthetic pelvic mesh used in minimally invasive ventral rectopexy. Methods Eight patients with pelvic organ prolapse were recruited for laparoscopic (LVMR) or robotic-assisted ventral mesh rectopexy (RVMR) with a synthetic MR–visible PVDF mesh. A follow-up visit was scheduled at 3 months after surgery. MR imaging was performed to evaluate the position and dimensions of the mesh and anatomical result. The visibility of the mesh in each sequence was assessed subjectively. Results The visibility of the mesh was best on T1-weighted flash images. The mesh was also well visualized on T2-weighted sagittal images. T2-weighted images, in general, provided best visualization of the surrounding anatomical structures and enabled assessment of the mesh fixation. Conclusions T2 sagittal and T1-weighted flash images provide the best information about the position and integrity of the iron oxide-impregnated PVDF mesh after LVMR or RVMR with a short examination time.
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Ballard DH, Jammalamadaka U, Tappa K, Weisman JA, Boyer CJ, Alexander JS, Woodard PK. 3D printing of surgical hernia meshes impregnated with contrast agents: in vitro proof of concept with imaging characteristics on computed tomography. 3D Print Med 2018; 4:13. [PMID: 30649673 PMCID: PMC6283811 DOI: 10.1186/s41205-018-0037-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 11/20/2018] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Selected medical implants and other 3D printed constructs could potentially benefit from the ability to incorporate contrast agents into their structure. The purpose of the present study is to create 3D printed surgical meshes impregnated with iodinated, gadolinium, and barium contrast agents and characterize their computed tomography (CT) imaging characteristics. Commercial fused deposition layering 3D printing was used to construct surgical meshes impregnated with imaging contrast agents in an in vitro model. Polycaprolactone (PCL) meshes were printed containing iodinated, gadolinium, or barium contrast; control PCL meshes without contrast were also fabricated. The three different contrast agents were mixed with PCL powder and directly loaded into the 3D printer. CT images of the three contrast-containing meshes and the control meshes were acquired and analyzed using small elliptical regions of interest to record the Hounsfield units (HU) of each mesh. Subsequently, to test their solubility and sustainability, the contrast-containing meshes were placed in a 37 °C agar solution for 7 days and imaged by CT at days 1, 3 and 7. RESULTS All 3D printed meshes were visible on CT. Iodinated contrast meshes had the highest attenuation (2528 mean HU), significantly higher than both and gadolinium (1178 mean HU) and barium (592 mean HU) containing meshes. Only barium meshes sustained their visibility in the agar solution; the iodine and gadolinium meshes were poorly perceptible and had significantly lower mean HU compared to their pre-agar solution imaging, with iodine and gadolinium present in the adjacent agar at day 7 CT. CONCLUSION 3D prints embedded with contrast materials through this method displayed excellent visibility on CT; however, only barium mesh maintained visibility after 7 days incubation on agar at human body temperature. This method of 3D printing with barium may have potential applications in a variety of highly personalized and CT visible medical devices.
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Affiliation(s)
- David H. Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, Campus Box 8131, St. Louis, MO 63110 USA
| | - Udayabhanu Jammalamadaka
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, Campus Box 8131, St. Louis, MO 63110 USA
| | - Karthik Tappa
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, Campus Box 8131, St. Louis, MO 63110 USA
| | - Jeffery A. Weisman
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, Campus Box 8131, St. Louis, MO 63110 USA
| | - Christen J. Boyer
- Molecular and Cellular Physiology, Louisiana State University Health Sciences Center, Shreveport, LA USA
| | - Jonathan Steven Alexander
- Molecular and Cellular Physiology, Louisiana State University Health Sciences Center, Shreveport, LA USA
| | - Pamela K. Woodard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, Campus Box 8131, St. Louis, MO 63110 USA
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Abstract
INTRODUCTION Today the use of textile meshes has become a standard for the treatment of abdominal wall hernias and for the reinforcement of any tissue repair as the strength of the implant decreases the recurrence rates. With increasing use, side effects of the textile implants became apparent, as well. AREAS COVERED Based on publications in Medline over the past decade, general and specific benefits, as well as risks, are discussed with the challenge to define individual risk-benefit ratios. For meshes, certain high-risk or low-risk conditions can be defined. In an attempt to eliminate mesh-related risks, quality control for medical devices has meanwhile been revised. In both the USA and the EU post-market surveillance studies are required to keep medical devices approved. EXPERT COMMENTARY The impact of material on the complication rate will vary depending on the patient's co-morbidity or the risks of the procedure. Even the best material can end up with disappointing results in case of poor healing or poor surgery. On the other hand, when using high-risk devices, most of the complications after excellent surgery with excellent indication can be supposed to be mesh-related. Thus, the use of low-risk devices is recommended even though its advantage may not be demonstrable in clinical studies.
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Affiliation(s)
- Uwe Klinge
- a Department of General , Visceral and Transplant Surgery at the University Hospital of the RWTH Aachen , Aachen , Germany
| | - Bernd Klosterhalfen
- b Department of Pathology , Institute for Pathology at the Düren Hospital , Düren , Germany
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