Is Magnetic Resonance Imaging (MRI) of the abdomen or Computed Tomography (CT) scan of the abdomen better for evaluating a mesh placement in Inguinal Hernia Repair?

From the Guidelines

CT scan is generally better than MRI for evaluating mesh placed during inguinal hernia repair. This is because CT scans provide superior visualization of the mesh material itself, allowing for better assessment of its position, integrity, and potential complications like migration or folding, as seen in various studies 1. The metal or synthetic components in surgical mesh often create artifacts on MRI that can obscure important details. CT scans are also faster, more widely available, and less expensive than MRI. However, MRI may be preferred in specific situations where soft tissue detail is paramount or when avoiding radiation exposure is critical, such as in young patients or those requiring multiple follow-up examinations.

Some key points to consider when choosing between CT and MRI for evaluating mesh placement include:

• The type of mesh used and its material composition
• The patient's age and potential need for repeated imaging
• The clinical question being addressed, such as assessing mesh position or detecting complications
• The availability and expertise of the imaging modalities at the institution

It's also important to note that while MRI has its limitations in evaluating mesh placement, it can be useful in certain situations, such as when soft tissue detail is critical or when radiation exposure needs to be minimized, as discussed in studies 1. Ultimately, the choice between CT and MRI should be guided by the specific clinical scenario and patient factors, with consideration of the potential benefits and limitations of each modality, as outlined in studies 1.

From the Research

Comparison of Imaging Modalities for Evaluating Mesh Placement in Inguinal Hernia Repair

• The study 2 compared the use of ultrasound (US) and computed tomography (CT) in evaluating postoperative complications after polypropylene mesh repair of inguinal hernia.
• The results showed that US was able to demonstrate the prosthetic mesh in the abdominal wall, while CT was only able to visualize the mesh in 2 out of 8 cases.
• This suggests that US may be a more effective imaging modality for evaluating mesh placement in inguinal hernia repair.

Mesh Repair vs. Non-Mesh Repair

• A systematic review 3 compared the outcomes of mesh and non-mesh repairs for inguinal and femoral hernias.
• The results showed that mesh repair probably reduces the risk of hernia recurrence compared to non-mesh repair.
• However, the review did not specifically address the issue of imaging modalities for evaluating mesh placement.

Prosthetic Mesh Repair for Incarcerated Inguinal Hernia

• A retrospective study 4 evaluated the outcomes of prosthetic mesh repair for incarcerated inguinal hernia.
• The results showed that polypropylene mesh can be safely used even in patients undergoing bowel resection.
• However, the study did not compare the use of different imaging modalities for evaluating mesh placement.

Comparison of Self-Adhesive Mesh and Polypropylene Mesh

• A prospective randomized controlled study 5 compared the short- and long-term results of self-adhesive mesh and conventional polypropylene mesh in Lichtenstein repair.
• The results showed that the self-adhesive mesh did not produce statistically significant advantages over the conventional polypropylene mesh, except for operative time.
• However, the study did not address the issue of imaging modalities for evaluating mesh placement.

Mesh Fixation for Laparoscopic Repair of Inguinal Hernia

• A protocol for systematic review and network meta-analysis 6 aimed to assess and compare the efficacy of different types of mesh fixation for laparoscopic repair of inguinal hernia.
• However, the study did not address the issue of imaging modalities for evaluating mesh placement.

Imaging Modalities for Evaluating Mesh Placement

• Based on the available evidence, it appears that ultrasound (US) may be a more effective imaging modality for evaluating mesh placement in inguinal hernia repair, as it is able to demonstrate the prosthetic mesh in the abdominal wall 2.
• However, there is limited evidence comparing the use of US and computed tomography (CT) for this purpose.
• Further studies are needed to determine the most effective imaging modality for evaluating mesh placement in inguinal hernia repair.