Cine magnetic resonance imaging vs high-resolution ultrasonography for detection of adhesions after laparoscopic and open incisional hernia repair: a matched pair pilot analysis.
BACKGROUND
Intraabdominal adhesions represent nonspecific complications before or after laparoscopic or open incisional hernia repair. The objective of this matched control pilot study was to display long-term adhesions noninvasively by applying functional cine magnetic resonance (MR) imaging, as compared with applying high-resolution ultrasonography (US).


METHODS
The study group, composed of 17 consecutive patients (12 men and 5 women; mean age, 52 years), underwent laparoscopic intraperitoneal onlay mesh repair using expanded polytetrafluoroethylene (ePTFE) mesh. Their mean body mass index was 30 kg/m(2), and the size of the hernia was 95 cm(2). Another group, matched for age, gender, and type of hernia, was subjected to open abdominal wall repair using the preperitoneal sublay technique with a large-pore, low-weight polypropylene mesh. For cine MR imaging (1.5 T), section-by-section dynamic depiction of induced visceral slide throughout the entire abdomen was achieved by applying transverse or sagittal true fast imaging with steady-state precession sequences. The location and type of adhesions were compared with high-resolution ultrasonography using nine segments of the abdominal map.


RESULTS
The patients subjected to laparoscopic and open incisional hernia repair were examined 16 and 28 months after surgery. The findings showed functional cine MR imaging as superior to high-resolution ultrasonography for assessing the amount of intraabdominal adhesions (n = 53 vs n = 3; p < 0.01). Most frequently, adhesions were seen between small bowel loops and the abdominal wall (n = 22), followed by bowel-to-bowel adhesions (n = 19; p < 0.05). However, adhesions between small bowel loops and the abdominal wall occurred more frequently after open mesh repair (p < 0.05). Furthermore, a strong correlation was observed between patient complaints and findings with cine MR imaging (p < 0.05). Maximum pain correlated significantly with the region of the most distinctive adhesions (p < 0.05).


CONCLUSIONS
Functional cine MR imaging represents a reliable noninvasive technique for detecting long-term adhesions after open and laparoscopic incisional hernia repair. The study results suggest that this approach has distinct advantages over high-resolution ultrasonography.
Mussack
T
T
Department of Surgery Innenstadt, Klinikum der Universität München, Nussbaumstrasse 20, 80336, München, Germany. Thomas.Mussack@med.uni-muenchen.de
Fischer
T
T
Ladurner
R
R
Gangkofer
A
A
Bensler
S
S
Hallfeldt
K K
KK
Reiser
M
M
Lienemann
A
A
D000328:Adult; D000368:Aged; D005260:Female; D006555:Hernia, Ventral / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D010865:Pilot Projects; D000267:Tissue Adhesions / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology*; D014463:Ultrasonography / Q000379:methods