Multidetector CT of expected findings and complications after contemporary inguinal hernia repair surgery

Abstract

A rguably the most frequent general surgery procedure, inguinal hernia repair (IHR) reaches an annual rate of approximately 200 operations per 100.000 people/years. Since the introduction of the open-mesh IHR by Lichtenstein in 1989, tension-free hernioplasty with prosthetic mesh (PM) implantation became the standard of care and decreased the likelihood of recurrence by approximately 50%. Furthermore, the increasing use of laparoscopy in IHR allows faster recovery, decreased postoperative pain, lower risk of postoperative seroma, wound infection and hemorrhage, lower incidence of chronic pain and long-term hernia recurrence-at the price of longer operative time and higher risk of rare yet serious visceral injuries (1-5).Since most general hospitals perform hundreds of IHR procedures each year, radiologists are increasingly requested to investigate suspected iatrogenic complications (6, 7).Some authors recommend ultrasonography (US) as a helpful first-line modality to assess the operated groin, which allows rapid and confident detection of anechoic fluid seromas abutting the PM. However, US is often hampered by obesity, thickened subcutaneous fat, medications, and local tenderness at the surgical wound. Furthermore, hypo-anechoic or septated collections corresponding to hematomas or abscesses are sonographically challenging to interpret (7,8).During the last decade, some focused radiologic reports described the expected postsurgical computed tomography (CT) appearances after PM-IHR, particularly the characteristic pseudolesions which are discussed in-depth in a dedicated section of this paper (6, 9). Conversely, very limited literature exists on cross-sectional imaging of iatrogenic complications, mostly including a 2004 review based on axial CT (10) and a recent paper generally devoted to imaging complications related to laparoscopic access (11).This paper provides an overview of contemporary IHR, reviews and illustrates the expected postoperative imaging appearances and iatrogenic injuries with emphasis on multidetector CT findings. Overview of surgical techniquesAs recent studies estimated a very low (<1%) risk of incarceration, a reducible inguinal hernia is not an indication for surgery unless the patient complains of pain or discomfort. E M E R G E N C Y R A D I O LO G Y P I C TO R I A L E S S AY ABSTRACTInguinal hernia repair (IHR) with prosthetic mesh implantation is the most common procedure in general surgery, and may be performed using either an open or laparoscopic approach. This paper provides an overview of contemporary tension-free IHR techniques and materials, and illustrates the expected postoperative imaging findings and iatrogenic injuries. Emphasis is placed on multidetector CT, which represents the ideal modality to comprehensively visualize the operated groin region and deeper intra-abdominal structures. CT consistently depicts seroma, mesh infections, hemorrhages, bowel complications and urinary bladder injuries, and thus generally provides a consistent basis for therapeutic choice. Since ...

The role of computed tomography in optimizing the surgical treatment of ventral hernias

“…За даними літератури, корисною є не тільки передопераційна, але й післяопераційна СКТ, яка доцільна у випадках розвитку ускладнень при пластиці гриж та може надати інформацію про наявність та характер післяопераційних ускладнень [11]. Ми вважаємо, що післяопераційне дослідження є досить корисним не тільки з точки зору діагностики ускладнень, але й для оцінки адекватності здійсненого оперативного втручання, про це згадують також інші автори [4].…”

“…According to the literature, it is useful to carry out both preoperative and postoperative SCT, which is reasonable in cases of hernioplasty complications and can provide information on the presence and nature of postoperative complications [11]. We believe that postoperative research is quite essential not only from the perspective of diagnosing complications, but also in terms of assessing the adequacy of surgery, that is also mentioned by other authors [4].…”

A Case of Rare Complication of Inguinal Parietoplasty according to Lichtenstein: Entero Cutaneous Fistula

“…Instead, it is not always available in emergency. The multidetector scanner would be, in everyday practice, the best morphological examination for diagnostic purposes [ 2 , 12 ].…”

Mind the gap: imaging spectrum of abdominal ventral hernia repair complications

“…Awareness of the type of hernia repair and interaction with the surgeon is important for better understanding of the postoperative field and hence useful reporting contributions. Commonly used investigations are ultrasonography (USG) and CT [7]. Radiographs are used in suspected cases of small bowel obstruction or perforation (Fig.…”