Research Article
Adhesions to Mesh after Ventral Hernia Mesh Repair Are
Detected by MRI but Are Not a Cause of Long Term Chronic
Abdominal Pain
Odd Langbach,
1
Stein Harald Holmedal,
2
Ole Jacob Grandal,
3
and Ola Røkke
1,4
1
Department of Gastroenterologic Surgery, Akershus University Hospital, P.O. Box 1000, 1478 Lorenskog, Norway
2
Department of Radiology, Akershus University Hospital, P.O. Box 1000, 1478 Lorenskog, Norway
3
Department of Radiology, Norwegian Radium Hospital, Oslo University Hospital, P.O. Box 4953, Nydalen, 0424 Oslo, Norway
4
Faculty of Medicine, University of Oslo, 0316 Oslo, Norway
Correspondence should be addressed to Odd Langbach; odd.langbach@ahus.no
Received 26 May 2015; Accepted 21 July 2015
Academic Editor: Marcello Picchio
Copyright © 2016 Odd Langbach et al. Tis is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Aim. Te aim of the present study was to perform MRI in patients afer 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%) afer follow-up, and 10
patients referred for late complaints afer ventral mesh repair. To verify the MRI-diagnosis of adhesions, laparoscopy was performed
afer 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 afer both LVHR and OVHR with a
sensitivity of 70%, specifcity 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. Te 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 afer open and laparoscopic hernia mesh repair and are not associated with chronic pain.
1. Introduction
Ventral hernia mesh repair is a common surgical procedure
and may be performed by open or laparoscopic technique.
Most patients have favorable outcome afer surgery, but
some patients experience problems such as pain, discomfort,
and hernia recurrences [1]. Hernia recurrence may explain
some of the complaints and can be diagnosed by clinical
investigation with the supplement of ultrasonography or
computed tomography (CT). In many cases, however, there is
no detectable cause of the patient’s symptoms. Te problems
in these patients are ofen assumed to come from neuralgias
caused by sutures, infammatory reaction to mesh fxation
materials or mesh, or even intra-abdominal adhesions, even
if such causes are difcult to verify. Te MRI technology
is a sensitive method to diagnose abdominal wall pathol-
ogy, but also adhesions [2] and is increasingly used in
the diagnosis of abdominal disease. Although ultrasound is a
dynamic tool, its capacity to detect adhesions is limited to the
subsurface of the abdominal wall. CT can detect seroma and
can also demonstrate typical adhesion-related complications
like strangulated obstruction or bowel ischemia. Even with
contrast-enhanced CT scan, adhesions cannot be detected
directly in most cases but can be assumed due to scar tissue,
bowel conglomerations, and luminal changes. Liberal use of
dynamic CT-imagines, however, should be selective due to
the radiation exposure.
Te aim of the present study was to perform MRI in a
clinically defned group of patients afer LVHR and OVHR,
respectively, in order to evaluate to what extent MRI is able
to detect the mesh implant and adhesions between the bowel
and the mesh or the abdominal wall. We also wanted to fnd
if adhesions could explain chronic pain afer ventral hernia
mesh repair.
Hindawi Publishing Corporation
Gastroenterology Research and Practice
Volume 2016, Article ID 2631598, 7 pages
http://dx.doi.org/10.1155/2016/2631598