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.MethodsFrom 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.ResultsAll 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.Conclusion4 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.
Highlights
Despite the ever-increasing focus on postoperative chronic pain, recurrence rates remain a mainstay of the outcome evaluation in hernia surgery
Intra-operatively three patients were excluded from further participation in the trial due to incidental findings of bilateral hernias (n = 2) or cord lipoma without an actual hernia (n = 1)
Changes in mesh size and configuration linked to in vivo properties of the implanted material, scarring processes or mesh migration have been discussed as potentially underlying reasons for local complications and recurrence after hernia surgery [1, 8]
Summary
Despite the ever-increasing focus on postoperative chronic pain, recurrence rates remain a mainstay of the outcome evaluation in hernia surgery. Postoperative mesh size and surface were usually analyzed at different points in time. All these factors do not discredit the mentioned publications in any way but may lead to limited reproducibility of the obtained results. Some trials evaluate the changes in implant size and shape after deflation of the abdomen at the end of laparoscopic procedures and find relevant changes in effective mesh size with regard to the initially planned overlap over hernia defects [5]. Lessons from previous valuable efforts in this field of research were learned and it is the aim of this study to evaluate the proneness of the chosen mesh implant towards shrinkage in a setting that yields as little variability of potentially biasing factors as possible
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