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Observational Study
. 2023 Jun;37(6):4604-4612.
doi: 10.1007/s00464-023-09938-3. Epub 2023 Feb 28.

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

Maaike Vierstraete  1 , Roel Beckers  2 , Lorenz Vangeel  2 , Brend Foriers  2 , Pieter Pletinckx  3 , Filip Muysoms  3
Affiliations
Observational Study

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

Maaike Vierstraete et al. Surg Endosc. 2023 Jun.

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.

Trial registration: ClinicalTrials.gov NCT03380312.

Keywords: Mesh shrinkage; Polyvinylidene fluoride; Retromuscular; Retrorectus; Ventral hernia; Visible mesh.

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Conflict of interest statement

The authors received a research grant from FEG textiltechnik the company producing the Dynamesh visible that was used in the study. This was mainly used for financing the MRI studies and the statistical analysis performed. The company had no influence on the initiation, the conduct and the manuscript preparation of the results. Outside of the study Maaike Vierstraete, Roel Beckers, Lorenz Vangeel, Brend Foriers and Pieter Pletinckx report no conflict of interest. Filip Muysoms reports having received research grants from Medtronic, Intuitive Surgical and FEG Textiltechnik, speakers’ honoraria from Medtronic, Bard Davol, Intuitive Surgical, FEG Textiltechnik and WL GORE & ass, consultancy honoraria from Sofradim, CMR surgical.

Figures

Fig. 1
Fig. 1
3DT1 MRI imaging in robot-assisted minimal invasive retrorectus hernia repair using an iron-oxide-loaded PVDF mesh. Calculations of the mesh surface area and maximal orthogonal diameters (width and length) are performed by drawing mesh contours following the endpoint of the mesh wires. Note the remarkable streak of iron-loaded particles at the left lateral border of the mesh
Fig. 2
Fig. 2
3DT1 MRI imaging in a patient who had a robot-assisted minimal invasive retrorectus ventral hernia repair using an iron-oxide-loaded PVDF mesh A MRI image at 1 month showing a postoperative seroma and a dehiscence of the hernia defect closure after an episode of heavy coughing B No residual seroma on MRI at 13 months postoperatively
Fig. 3
Fig. 3
Histogram on the shrinkage rates between 1 and 13 months after robot-assisted minimal invasive retrorectus hernia repair using an iron-oxide-loaded PVDF mesh, in relation to the number of patients
Fig. 4
Fig. 4
Graphical illustration on the degree of mesh shrinkage after robot-assisted minimal invasive retrorectus ventral hernia repair in relation to the patients’ body mass indices at the time of the surgery
See this image and copyright information in PMC

References

    1. Nguyen MT, Berger RL, Hicks SC, Davila JA, Li LT, Kao LS, et al. Comparison of outcomes of synthetic mesh vs suture repair of elective primary ventral herniorrhaphy. JAMA Surg. 2014;149(5):415. doi: 10.1001/jamasurg.2013.5014. - DOI - PubMed
    1. Henriksen NA, Montgomery A, Kaufmann R, Berrevoet F, East B, Fischer J, et al. Guidelines for treatment of umbilical and epigastric hernias from the European Hernia Society and Americas Hernia Society. Br J Surg. 2020;107(3):171–190. doi: 10.1002/bjs.11489. - DOI - PubMed
    1. Zinther NB, Wara P, Friis-Andersen H. Shrinkage of intraperitoneal onlay mesh in sheep: coated polyester mesh versus covered polypropylene mesh. Hernia. 2010;14(6):611–615. doi: 10.1007/s10029-010-0682-z. - DOI - PubMed
    1. Harsløf S, Zinther N, Harsløf T, Danielsen C, Wara P, Friis-Andersen H. Mesh shrinkage depends on mesh properties and anchoring device: an experimental long-term study in sheep. Hernia. 2016;21(1):107–113. doi: 10.1007/s10029-016-1528-0. - DOI - PubMed
    1. Carter PR, LeBlanc KA, Hausmann MG, Whitaker JM, Rhynes VK, Kleinpeter KP, et al. Does expanded polytetrafluoroethylene mesh really shrink after laparoscopic ventral hernia repair? Hernia. 2011;16(3):321–325. doi: 10.1007/s10029-011-0898-6. - DOI - PubMed

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