title: First human magnetic resonance visualisation of prosthetics for laparoscopic large hiatal hernia repair.
abstract: OBJECTIVE
  Mesh repair of large hiatal hernias has increasingly gained popularity to reduce recurrence rates. Integration of iron particles into the polyvinylidene fluoride mesh-based material allows for magnetic resonance visualisation (MR).
  
  
  METHODS
  In a pilot prospective case series eight patients underwent surgical repair of hiatal hernias repair with pre-shaped meshes, which were fixated with fibrin glue. An MR investigation with a qualified protocol was performed on postoperative day four and 3 months postoperatively to evaluate the correct position of the mesh by assessing mesh appearance and demarcation. The total MR-visible mesh surface area of each implant was calculated and compared with the original physical mesh size to evaluate potential reduction of the functional mesh surfaces.
  
  
  RESULTS
  We documented no mesh migrations or dislocations but we found a significant decrease of MR-visualised total mesh surface area after release of the pneumoperitoneum compared to the original mesh size (mean 78.9 vs 84 cm(2); mean reduction of mesh area = 5.1 cm(2), p < 0.001). At 3 months postoperatively, a further reduction of the mesh surface area could be observed (mean 78.5 vs 78.9 cm(2); mean reduction of mesh area = 0.4 cm(2), p < 0.037).
  
  
  CONCLUSIONS
  Detailed mesh depiction and accurate assessment of the surrounding anatomy could be successfully achieved in all cases. Fibrin glue seems to provide effective mesh fixation. In addition to a significant early postoperative decrease in effective mesh surface area a further reduction in size occurred within 3 months after implantation.
authors.affiliation: Department of General and Visceral Surgery, Sisters of Charity Hospital, 4010, Linz, Austria. gernot.koehler@bhs.at.|Academic Teaching Hospital of the Medical Universities Graz and Innsbruck, Graz, Austria. gernot.koehler@bhs.at.|Department of Surgery, Paracelsus Medical University, Salzburg, Austria. gernot.koehler@bhs.at.
authors.forename: G
authors.initials: G
authors.lastname: Köhler
authors.affiliation: Department of Diagnostic and Interventional Radiology, Sisters of Charity Hospital, Linz, Austria.|Academic Teaching Hospital of the Medical Universities Graz and Innsbruck, Graz, Austria.
authors.forename: L
authors.initials: L
authors.lastname: Pallwein-Prettner
authors.affiliation: Department of Surgery, Paracelsus Medical University, Salzburg, Austria.
authors.forename: M
authors.initials: M
authors.lastname: Lechner
authors.affiliation: Department of General and Visceral Surgery, Sisters of Charity Hospital, 4010, Linz, Austria.|Academic Teaching Hospital of the Medical Universities Graz and Innsbruck, Graz, Austria.|Department of Surgery, Paracelsus Medical University, Salzburg, Austria.
authors.forename: G O
authors.initials: GO
authors.lastname: Spaun
authors.affiliation: Department of General and Visceral Surgery, Sisters of Charity Hospital, 4010, Linz, Austria.|Academic Teaching Hospital of the Medical Universities Graz and Innsbruck, Graz, Austria.|Department of Surgery, Paracelsus Medical University, Salzburg, Austria.
authors.forename: O O
authors.initials: OO
authors.lastname: Koch
authors.affiliation: Department of General and Visceral Surgery, Sisters of Charity Hospital, 4010, Linz, Austria.|Academic Teaching Hospital of the Medical Universities Graz and Innsbruck, Graz, Austria.
authors.forename: K
authors.initials: K
authors.lastname: Emmanuel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D015718:Fibrin Tissue Adhesive; D006551:Hernia, Hiatal / Q000175:diagnosis* / Q000601:surgery*; D059685:Herniorrhaphy; D006801:Humans; D058085:Iron Compounds; D010535:Laparoscopy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D019736:Prostheses and Implants; D011475:Prosthesis Failure; D013526:Surgical Mesh
chemical_list: D015718:Fibrin Tissue Adhesive; D058085:Iron Compounds
keywords: Hiatus hernia; MR visible; MRI; Magnetic resonance; Mesh repair; PVDF