S. W. Ross1, J. D. Watkins1, L. J. Blair1, A. E. Lincourt1, V. A. Augenstein1, B. T. Heniford1 1Carolinas Medical Center,Charlotte, NC, USA
Introduction: Pre-operative assessment of ventral incisional hernias is often aided by abdominal CT imaging. We hypothesized that pre-operative CT measurements of defect and abdominal wall thickness(AWT) will correlate with complications and need for complex abdominal wall reconstruction(AWR).
Methods: A prospective, institutional, hernia specific database was queried for all OVHR from 2008-2012 and patients with preoperative CT of the abdomen/pelvis were selected. CT measurements were obtained of the hernia defect width, length, and AWT at multiple sites. Standard statistical methods were used to evaluate the association of CT measurements with the need for component separation, panniculectomy, as well as wound complications, total complications and hernia recurrence. Principal component analysis(PCA) was employed to analyze CT measurements and BMI.
Results: There were 151 OVHR with CT data. In total, average: age 55.3±12.5 years, BMI 33.3±7.8 kg/m2, defect width 8.6±5.0cm, area 178.3±214cm2, AWT at umbilicus 3.5±1.8cm, and AWT at pubis 7.0±3.2. The OVHR population was: 37.7% male, 60.3% were recurrent, 24.0% had a component separation and 34.4% required panniculectomy. The rate of wound and total complications were 13.25% and 39.1% respectively. Recurrence rate was 2.7%. PCA was used to create a variable using six key CT measurements and BMI. The analysis showed the following techniques or outcomes were associated with increasing CT measurements: component separation(defect width, length, and area); panniculectomy(all measurements excluding retrorenal); wound complications(all measurements excluding hip girdle and retrorenal); total complications(defect width, length, area and pubic symphysis AWT);all p<0.05. Using multivariate regression, increasing PCA was independently associated with wound complications OR 1.08, CI (1.01-1.16).
Conclusion: Pre-operative CT measurements of hernia defects and abdominal wall thickness can predict wound complications and the need for complex AWR techniques. Additionally, increasing measurements correlate significantly with hernia recurrence. Consequently, PCA may be used in the future to calculate pre-operative risk and to predict the operative approach for OVHR.