Background

Sacrocolpopexy (SC) involves suspension of the vaginal vault or cervix to the sacrum using a mesh. Following insertion, the meshes have been observed to have undergone dimensional changes.

Objective

To quantify dimensional changes of meshes following implantation and characterize their morphology in-vivo.

Design setting and participants

24 patients underwent SC using PolyVinyliDeneFluoride mesh loaded with Fe₃O₄ particles. Tailored anterior and posterior mesh flaps were sutured to the respective vaginal walls, uniting at the apex. The posterior flap continued to the sacrum and was attached there. Meshes were visualized on magnetic resonance (MR) imaging at 12 [3–12] (median [range]) months postoperatively and 3D models of the mesh were generated. Dynamic MR sequences were acquired during valsalva to record mesh mobility.

Outcome measures

The area of the vagina effectively supported by the mesh (Effective Support Area (ESA)) was calculated. The 3D models’ wall thickness map was analyzed to identify the locations of mesh folding. Intraclass correlation (ICC) was calculated to test the reliability of the methods. To measure the laxity and flatness of the mesh, the curvature and the ellipticity of the sacral flap were calculated.

Results

The ESA calculation methodology had ICC = 0.97. A reduction of 75.49 [61.55–78.67] % (median [IQR]) in area, 47.64 [38.07–59.81] % in anterior flap, and of 23.95 [10.96–27.21] % in the posterior flap was measured. The mesh appeared thicker near its attachment at the sacral promontory (n = 19) and near the vaginal apex (n = 22). The laxity of the mesh was 1.13 [1.10–1.16] and 60.55 [49.76–76.25] % of the sacral flap was flat. We could not reliably measure mesh mobility (ICC = 0.16).

Conclusion

A methodology for complete 3D characterization of SC meshes using MR images was presented. After implantation, the supported area is much lower than what is prepared prior to implantation. We propose this happened during the surgery itself.

中文翻译：

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磁共振成像测量sa小肠网的短期术后变形

背景

Sacrocolpopexy（SC）涉及使用网片将阴道穹or或子宫颈悬吊至the骨。插入之后，已经观察到网孔已经发生尺寸变化。

客观的

为了量化植入后网孔的尺寸变化并表征其体内形态。

设计环境和参与者

24名患者使用装有Fe ₃ O ₄颗粒的PolyVinyliDeneFluoride筛网进行了​​SC治疗。将量身定制的前，后网状皮瓣缝合到各自的阴道壁上，并在顶端结合在一起。后皮瓣一直延伸到and骨，并固定在there骨上。术后12 [3–12]（中位[范围]）个月，通过磁共振（MR）成像对网格进行可视化，并生成网格的3D模型。在瓦尔萨尔瓦（Valsalva）期间获取动态MR序列，以记录网格的活动性。

结果指标

计算了网眼有效支撑的阴道面积（有效支撑面积（ESA））。分析了3D模型的壁厚图以识别网格折叠的位置。计算类内相关性（ICC）以测试方法的可靠性。为了测量网格的松弛度和平坦度，计算了flap骨瓣的曲率和椭圆度。

结果

ESA计算方法的ICC = 0.97。测量面积减少75.49 [61.55–78.67]％（中位[IQR]），前皮瓣减少47.64 [38.07–59.81]％，后皮瓣减少23.95 [10.96–27.21]％。mesh骨附着处靠近网孔处（n = 19），阴道顶点附近（n = 22），网孔显得较厚。mesh的松弛度为1.骨皮瓣的1.13 [1.10-1.16]和60.55 [49.76-76.25]％。我们无法可靠地测量网格移动性（ICC = 0.16）。

结论

提出了使用MR图像对SC网格进行完整3D表征的方法。植入后，支撑区域比植入前准备的要低得多。我们建议这是在手术本身发生的。