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dos Santos PV, Hirano ES. Experimental evaluation of the use of starch and carboxymethylcellulose in the prevention of intraperitoneal adhesions in hernia surgery with coated meshes. Acta Cir Bras 2023; 38:e383323. [PMID: 37729350 PMCID: PMC10508194 DOI: 10.1590/acb383323] [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: 05/26/2023] [Accepted: 07/11/2023] [Indexed: 09/22/2023] Open
Abstract
PURPOSE Laparoscopic hernia repair involves a risk of adhesion between coated mesh and viscera. Plant polysaccharides such as starch and carboxymethylcellulose (SC) make up a product that acts as a barrier and prevents intraperitoneal adhesions. This study aimed to evaluate whether topical SC can also reduce adhesions between mesh and intra-abdominal organs. METHODS Forty rats each received placement of two intraperitoneal mesh fragments, one on each side of the abdominal wall. Randomly, 20 animals received SC on the right and other 20 on the left, leaving the contralateral side as a control. Fourteen days after the surgery, the animals underwent an additional laparotomy in which macroscopic analysis was performed. RESULTS As for the percentage of the mesh area affected by adhesion, one (2.6%) animal had > 75% adhesion on the experimental side, and 11 animals (28.9%) on the control side. The adhesion intensity score showed firm adhesions in three (7.9%) animals on the experimental side and nine (23.7%) on the control side. CONCLUSIONS The use of SC decreased the intensity of adhesions and the surface area of the mesh affected by adhesions. There was no negative interference of the product in the incorporation of the mesh into the abdominal wall.
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Affiliation(s)
- Paulo Vicente dos Santos
- Universidade Estadual de Campinas – Postgraduate Program in Surgical Science – Campinas SP – Brazil
| | - Elcio Shiyoiti Hirano
- Universidade Estadual de Campinas – Postgraduate Program in Surgical Science – Campinas SP – Brazil
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Ahmed HA, Bu Shurbak ZS, Babarinsa IA, Hussain Saleh HA, Khenyab N, Ahmed Z, Minisha F. Small Bowel Injury During Peritoneal Entry at Cesarean Section: A Five-Year Case Series. Cureus 2022; 14:e31072. [DOI: 10.7759/cureus.31072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2022] [Indexed: 11/06/2022] Open
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Favourable outcomes after Retro-Rectus (Rives-Stoppa) Mesh Repair as Treatment for Non-Complex Ventral Abdominal Wall Hernia, a Systematic Review and Meta-Analysis. Ann Surg 2022; 276:55-65. [PMID: 35185120 DOI: 10.1097/sla.0000000000005422] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess prevalence of hernia recurrence, surgical site infection (SSI), seroma, serious complications, and mortality after retro-rectus repair. SUMMARY BACKGROUND DATA Ventral abdominal wall hernia is a common problem, tied to increasing frailty and obesity of patients undergoing surgery. For non-complex ventral hernia, retro-rectus (Rives-Stoppa) repair is considered the gold standard treatment. Level-1 evidence confirming this presumed superiority is lacking. METHODS Five databases were searched for studies reporting on retro-rectus repair. Single-armed and comparative randomized and non-randomized studies were included. Outcomes were pooled with mixed-effects, inverse variance or random-effects models. RESULTS Ninety-three studies representing 12440 patients undergoing retro-rectus repair were included. Pooled hernia recurrence was estimated at 3.2% (95%CI: 2.2-4.2%, n = 11049) after minimally 12 months and 4.1%, (95%CI: 2.9-5.5%, n = 3830) after minimally 24 months. Incidences of SSI and seroma were estimated at respectively 5.2% (95%CI: 4.2-6.4%, n = 4891) and 5.5% (95%CI: 4.4-6.8%, n = 3650). Retro-rectus repair was associated with lower recurrence rates compared to onlay repair (OR: 0.27, 95%CI: 0.15-0.51, p < 0.001) and equal recurrence rates compared to intraperitoneal onlay (IPOM) repair (OR: 0.92, 95%CI: 0.75-1.12, p = 0.400). Retro-rectus repair was associated with more SSI than IPOM repair (OR: 1.8, 95%CI: 1.03-3.14, p = 0.038). Minimally invasive retro-rectus repair displayed low rates of recurrence (1.3%, 95%CI: 0.7-2.3%, n = 849) and SSI (1.5%, 95%CI: 0.8-2.8%, n = 982), albeit based on non-randomized studies. CONCLUSIONS Retro-rectus (Rives-Stoppa) repair results in excellent outcomes, superior or similar to other techniques for all outcomes except surgical site infection. The latter rarely occurred, yet less frequently after IPOM repair, which is usually performed by laparoscopy.
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Gu Y, Wang P, Li H, Tian W, Tang J. Chinese expert consensus on adult ventral abdominal wall defect repair and reconstruction. Am J Surg 2020; 222:86-98. [PMID: 33239177 DOI: 10.1016/j.amjsurg.2020.11.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Surgical management of patients with ventral abdominal wall defects, especially complex abdominal wall defects, remains a challenging problem for abdominal wall reconstructive surgeons. Effective surgical treatment requires appropriate preoperative assessment, surgical planning, and correct operative procedure in order to improve postoperative clinical outcomes and minimize complications. Although substantial advances have been made in surgical techniques and prosthetic technologies, there is still insufficient high-level evidence favoring a specific technique. Broad variability in existing practice patterns, including clinical pre-operative evaluation, surgical techniques and surgical procedure selection, are still common. DATA SOURCES With the purpose of providing a best practice algorithm, a comprehensive search was conducted in Medline and PubMed. Sixty-four surgeons considered as experts on abdominal wall defect repair and reconstruction in China were solicited to develop a Chinese consensus and give recommendations to help surgeons standardize their techniques and improve clinical results. CONCLUSIONS This consensus serves as a starting point to provide recommendations for adult ventral abdominal wall repair and reconstruction in China and may help build opportunities for international cooperation to refine AWR practice.
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Affiliation(s)
- Yan Gu
- Hernia and Abdominal Wall Disease Center, Shanghai Jiao Tong University, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
| | - Ping Wang
- Department of Hernia Surgery, Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China
| | - Hangyu Li
- Department of General Surgery, Fourth Hospital of China Medical University, Shenyang, 110000, China
| | - Wen Tian
- Department of General Surgery, Chinese People's Liberation Army General Hospital, Beijing, 100853, China.
| | - Jianxiong Tang
- Department of General Surgery, Huadong Hospital, Fudan University, Shanghai, 200040, China.
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Earle D, Roth JS, Saber A, Haggerty S, Bradley JF, Fanelli R, Price R, Richardson WS, Stefanidis D. SAGES guidelines for laparoscopic ventral hernia repair. Surg Endosc 2016; 30:3163-83. [PMID: 27405477 DOI: 10.1007/s00464-016-5072-x] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 06/21/2016] [Indexed: 01/21/2023]
Affiliation(s)
- David Earle
- Ochsner Clinic, 1514 Jefferson Highway, New Orleans, LA, 70121, USA
| | - J Scott Roth
- Ochsner Clinic, 1514 Jefferson Highway, New Orleans, LA, 70121, USA
| | - Alan Saber
- Ochsner Clinic, 1514 Jefferson Highway, New Orleans, LA, 70121, USA
| | - Steve Haggerty
- Ochsner Clinic, 1514 Jefferson Highway, New Orleans, LA, 70121, USA
| | - Joel F Bradley
- Ochsner Clinic, 1514 Jefferson Highway, New Orleans, LA, 70121, USA
| | - Robert Fanelli
- Ochsner Clinic, 1514 Jefferson Highway, New Orleans, LA, 70121, USA
| | - Raymond Price
- Ochsner Clinic, 1514 Jefferson Highway, New Orleans, LA, 70121, USA
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Adhesions to Mesh after Ventral Hernia Mesh Repair Are Detected by MRI but Are Not a Cause of Long Term Chronic Abdominal Pain. Gastroenterol Res Pract 2015; 2016:2631598. [PMID: 26819601 PMCID: PMC4706901 DOI: 10.1155/2016/2631598] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 07/21/2015] [Indexed: 12/22/2022] Open
Abstract
Aim. The aim of the present study was to perform MRI in patients after ventral hernia mesh repair, in order to evaluate MRI's ability to detect intra-abdominal adhesions. Materials and Methods. Single-center long term follow-up study of 155 patients operated for ventral hernia with laparoscopic (LVHR) or open mesh repair (OVHR), including analyzing medical records, clinical investigation with patient-reported pain (VAS-scale), and MRI. MRI was performed in 124 patients: 114 patients (74%) after follow-up, and 10 patients referred for late complaints after ventral mesh repair. To verify the MRI-diagnosis of adhesions, laparoscopy was performed after MRI in a cohort of 20 patients. Results. MRI detected adhesions between bowel and abdominal wall/mesh in 60% of the patients and mesh shrinkage in 20-50%. Adhesions were demonstrated to all types of meshes after both LVHR and OVHR with a sensitivity of 70%, specificity of 75%, positive predictive value of 78%, and negative predictive value of 67%. Independent predictors for formation of adhesions were mesh area as determined by MRI and Charlson index. The presence of adhesions was not associated with more pain. Conclusion. MRI can detect adhesions between bowel and abdominal wall in a fair reliable way. Adhesions are formed both after open and laparoscopic hernia mesh repair and are not associated with chronic pain.
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Guillaume O, Teuschl AH, Gruber-Blum S, Fortelny RH, Redl H, Petter-Puchner A. Emerging Trends in Abdominal Wall Reinforcement: Bringing Bio-Functionality to Meshes. Adv Healthc Mater 2015; 4:1763-89. [PMID: 26111309 DOI: 10.1002/adhm.201500201] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 05/12/2015] [Indexed: 12/19/2022]
Abstract
Abdominal wall hernia is a recurrent issue world-wide and requires the implantation of over 1 million meshes per year. Because permanent meshes such as polypropylene and polyester are not free of complications after implantation, many mesh modifications and new functionalities have been investigated over the last decade. Indeed, mesh optimization is the focus of intense development and the biomaterials utilized are now envisioned as being bioactive substrates that trigger various physiological processes in order to prevent complications and to promote tissue integration. In this context, it is of paramount interest to review the most relevant bio-functionalities being brought to new meshes and to open new avenues for the innovative development of the next generation of meshes with enhanced properties for functional abdominal wall hernia repair.
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Affiliation(s)
- Olivier Guillaume
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology; Donaueschingenstraße 13 A-1200 Vienna Austria
- Austrian Cluster for Tissue Regeneration; Donaueschingenstrasse 13 A-1200 Vienna Austria
| | - Andreas Herbert Teuschl
- Austrian Cluster for Tissue Regeneration; Donaueschingenstrasse 13 A-1200 Vienna Austria
- University of Applied Sciences Technikum Wien; Department of Biochemical Engineering; Höchstädtplatz 5 1200 Vienna Austria
| | - Simone Gruber-Blum
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology; Donaueschingenstraße 13 A-1200 Vienna Austria
- Austrian Cluster for Tissue Regeneration; Donaueschingenstrasse 13 A-1200 Vienna Austria
- Department of General Visceral and Oncological Surgery; Wilhelminenspital der Stadt Wien; Montleartstraße 37 A-1171 Vienna Austria
| | - René Hartmann Fortelny
- Austrian Cluster for Tissue Regeneration; Donaueschingenstrasse 13 A-1200 Vienna Austria
- Department of General Visceral and Oncological Surgery; Wilhelminenspital der Stadt Wien; Montleartstraße 37 A-1171 Vienna Austria
| | - Heinz Redl
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology; Donaueschingenstraße 13 A-1200 Vienna Austria
- Austrian Cluster for Tissue Regeneration; Donaueschingenstrasse 13 A-1200 Vienna Austria
| | - Alexander Petter-Puchner
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology; Donaueschingenstraße 13 A-1200 Vienna Austria
- Austrian Cluster for Tissue Regeneration; Donaueschingenstrasse 13 A-1200 Vienna Austria
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Silecchia G, Campanile FC, Sanchez L, Ceccarelli G, Antinori A, Ansaloni L, Olmi S, Ferrari GC, Cuccurullo D, Baccari P, Agresta F, Vettoretto N, Piccoli M. Laparoscopic ventral/incisional hernia repair: updated Consensus Development Conference based guidelines [corrected]. Surg Endosc 2015; 29:2463-84. [PMID: 26139480 DOI: 10.1007/s00464-015-4293-8] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 04/27/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND The Executive board of the Italian Society for Endoscopic Surgery (SICE) promoted an update of the first evidence-based Italian Consensus Conference Guidelines 2010 because a large amount of literature has been published in the last 4 years about the topics examined and new relevant issues. METHODS The scientific committee selected the topics to be addressed: indications to surgical treatment including special conditions (obesity, cirrhosis, diastasis recti abdominis, acute presentation); safety and outcome of intraperitoneal meshes (synthetic and biologic); fixing devices (absorbable/non-absorbable); abdominal border and parastomal hernia; intraoperative and perioperative complications; and recurrent ventral/incisional hernia. All the recommendations are the result of a careful and complete literature review examined with autonomous judgment by the entire panel. The process was supervised by experts in methodology and epidemiology from the most qualified Italian institution. Two external reviewers were designed by the EAES and EHS to guarantee the most objective, transparent, and reliable work. The Oxford hierarchy (OCEBM Levels of Evidence Working Group*. "The Oxford 2011 Levels of Evidence") was used by the panel to grade clinical outcomes according to levels of evidence. The recommendations were based on the grading system suggested by the GRADE working group. RESULTS AND CONCLUSIONS The availability of recent level 1 evidence (a meta-analysis of 10 RCTs) allowed to recommend that not only laparoscopic repair is an acceptable alternative to the open repair, but also it is advantageous in terms of shorter hospital stay and wound infection rate. This conclusion appears to be extremely relevant in a clinical setting. Indications about specific conditions could also be issued: laparoscopy is recommended for the treatment of recurrent ventral hernias and obese patients, while it is a potential option for compensated cirrhotic and childbearing-age female patients. Many relevant and controversial topics were thoroughly examined by this consensus conference for the first time. Among them are the issue of safety of the intraperitoneal mesh placement, traditionally considered a major drawback of the laparoscopic technique, the role for the biologic meshes, and various aspects of the laparoscopic approach for particular locations of the defect such as the abdominal border or parastomal hernias.
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Affiliation(s)
- Gianfranco Silecchia
- Division of General Surgery and Bariatric Centre of Excellence, Department of Medico-Surgical Sciences and Biotechnology, Sapienza University of Rome, Via Faggiana 1668, 04100, Latina, LT, Italy
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10
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The Radiologic Appearance of Prosthetic Materials Used in Hernia Repair and a Recommended Classification. AJR Am J Roentgenol 2013; 201:1180-3. [DOI: 10.2214/ajr.13.10703] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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First In-Human Magnetic Resonance Visualization of Surgical Mesh Implants for Inguinal Hernia Treatment. Invest Radiol 2013; 48:770-8. [DOI: 10.1097/rli.0b013e31829806ce] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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In vivo visualization of polymer-based mesh implants using conventional magnetic resonance imaging and positive-contrast susceptibility imaging. Invest Radiol 2013; 48:200-5. [PMID: 23344516 DOI: 10.1097/rli.0b013e31827efd14] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Polymer-based textile meshes for abdominal hernia treatment are invisible by conventional imaging methods, including magnetic resonance imaging (MRI). Integration of iron particles in the mesh base material allows MRI visualization of meshes. Positive-contrast susceptibility imaging (PCSI) was implemented to separate susceptibility-induced voids from proton-deficient voids. The purpose of this study was to compare PCSI with conventional gradient echo and turbo spin echo (TSE) sequences for the in vivo assessment of superparamagnetic iron oxide particle-loaded surgical meshes in an animal model. METHODS AND MATERIALS Iron-loaded polymer meshes were implanted into the abdominal wall of 10 rabbits. At days 1, 30, and 90 after surgery, conventional gradient echo, TSE, and PCSI were performed at 1.5 T in the sagittal and axial planes. Images were scored by 2 radiologists with respect to mesh visibility, delineation of the surrounding tissue, differentiation from other structures, and overall diagnostic use, on a 4-point scale ranging from 1 (insufficient) to 4 (excellent). The results were compared using Wilcoxon signed-rank tests. The mesh shape, possible deformation or fracture, and possible mesh migration were evaluated on the different pulse sequences and compared with the results at surgery and autopsy. RESULTS The iron-loaded meshes appeared as hypointense signal voids on gradient echo sequences, as a hyperintense line on PCSI, and as a very thin dark line on TSE images. In all animals, a precise depiction of the mesh location and its spatial configuration and integrity was possible by MRI and confirmed by surgical and autopsy results. In all 4 categories and at all 3 time points of imaging, image quality scores were significantly higher for gradient echo imaging (range, 3.60-3.80) compared with PCSI (range, 3.12-3.42) and TSE (range, 1.64-1.89). At day 90, the image quality ratings of gradient echo and PCSI were comparable. In 2 cases, the complete delineation of mesh borders was impossible because of signal voids of adjacent anatomical structures, whereas PCSI helped achieve this differentiation. CONCLUSION In this rabbit model of iron-loaded implanted abdominal meshes, standard gradient echo imaging was best suitable to assess implant location, integrity, and configuration. In 2 of 10 animals, PCSI helped achieve a complete delineation of mesh borders.
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Guillaume O, Blanquer S, Letouzey V, Paniagua C, Lemaire L, Franconi F, Lavigne JP, Lefranc O, Gravagna P, de Tayrac R, Coudane J, Garric X. Conception d’un treillis anti-infectieux et visible en IRM pour la prise en charge chirurgicale des prolapsus génitaux et des hernies abdominales. Ing Rech Biomed 2012. [DOI: 10.1016/j.irbm.2012.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kuehnert N, Kraemer NA, Otto J, Donker HCW, Slabu I, Baumann M, Kuhl CK, Klinge U. In vivo MRI visualization of mesh shrinkage using surgical implants loaded with superparamagnetic iron oxides. Surg Endosc 2011; 26:1468-75. [PMID: 22179447 PMCID: PMC3327833 DOI: 10.1007/s00464-011-2057-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2011] [Accepted: 11/08/2011] [Indexed: 12/16/2022]
Abstract
BACKGROUND Prosthetic mesh implants are widely used in hernia surgery. To show long-term mesh-related complications such as shrinkage or adhesions, a precise visualization of meshes and their vicinity in vivo is important. By supplementing mesh fibers with ferro particles, magnetic resonance imaging (MRI) can help to delineate the mesh itself. This study aimed to demonstrate and quantify time-dependent mesh shrinkage in vivo by MRI. METHODS Polyvinylidenfluoride (PVDF) meshes with incorporated superparamagnetic iron oxides (SPIOs) were implanted as an abdominal wall replacement in 30 rats. On days 1, 7, 14, or 21, MRI was performed using a gradient echo sequence with repetition time (TR)/echo time (TE) of 50/4.6 and a flip angle of 20°. The length, width, and area of the device were measured on axial, coronal, and sagittal images, and geometric deformations were assessed by surgical explantation. RESULTS In all cases, the meshes were visualized and their area estimated by measuring the length and width of the mesh. The MRI presented a mean area shrinkage in vivo of 13% on day 7, 23% on day 14, and 23% on day 21. Postmortem measurements differed statistically from MRI, with a mean area shrinkage of 23% on day 7, 28% on day 14, and 30% on day 21. Ex vivo measurements of shrinkage showed in vivo measurements to be overestimated approximately 8%. Delineation of the mesh helped to show folding or adhesions close to the intestine. CONCLUSION Loading of surgical meshes with SPIOs allows their precise visualization during MRI and guarantees an accurate in vivo assessment of their shrinkage. The authors' observation clearly indicates that shrinkage in vivo is remarkably less than that shown by illustrated explantation measurements. The use of MRI with such meshes could be a reliable technique for checking on proper operation of implanted meshes and showing related complications, obviating the need for exploratory open surgical revision.
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Affiliation(s)
- Nicolas Kuehnert
- Department of Surgery, University Hospital, RWTH Aachen University, 52074, Aachen, Germany.
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Affiliation(s)
- Oleksandr Seleverstov
- Department of Surgery University of Virginia Health System Charlottesville, Virginia
| | - Peter T. Hallowell
- Department of Surgery University of Virginia Health System Charlottesville, Virginia
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Junge K, Binnebösel M, von Trotha KT, Rosch R, Klinge U, P. Neumann U, Lynen Jansen P. Mesh biocompatibility: effects of cellular inflammation and tissue remodelling. Langenbecks Arch Surg 2011; 397:255-70. [DOI: 10.1007/s00423-011-0780-0] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Accepted: 03/08/2011] [Indexed: 12/22/2022]
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