M. L. Moses1, C. Hannon1, D. V. Cherla1, K. Mueck1, J. L. Holihan1, S. Millas1, C. J. Wray1, L. S. Kao1, T. C. Ko1, M. K. Liang1 1University Of Texas Health Science Center At Houston,General Surgery,Houston, TX, USA
Introduction:
Despite the prevalence of umbilical hernia and diastasis recti in the general population, it is unknown if the presence of either increases the risk of developing a ventral incisional hernia (VIH). We hypothesize that among patients undergoing abdominal surgery, individuals with an umbilical hernia or diastasis rectus have an increased risk of developing a postoperative VIH.
Methods:
This was a retrospective study of all patients undergoing surgery for gastrointestinal cancer at a single institution from January 2011 to December 2015. These patients were chosen because of their high likelihood of having both preoperative and postoperative CT imaging. Inclusion criteria included all patients undergoing surgery with a periumbilical incision and both preoperative and postoperative CT scans. To ensure that the baseline umbilical hernias were not VIHs from previous operations, all patients with previous abdominal surgeries were excluded. The primary outcome was whether a VIH was visualized on postoperative CT scan. Primary outcome was compared by chi-square statistical analysis.
Results:
A total of 159 patients met inclusion criteria and were followed for a median(range) of 41.7(21.7-79.3) months. Prior to surgery, 93(58% of the included cohort) had a radiographic umbilical hernia and 67(42%) had a diastasis rectus. Following surgery, patients with a prior umbilical hernia were more likely to have a VIH on postoperative CT scan (67/93,72% versus 26/66,40%, p<0.001) while patients with a preoperative diastasis rectus were not more likely to acquire a postoperative VIH (39/67,58% versus 56/92,61%, p=0.746).
Conclusion:
Umbilical hernias but not diastasis recti are associated with an increased risk of developing a postoperative VIH. In addition, the prevalence of ventral hernias seen on CT scans before and after abdominal surgery is substantial. Further studies are needed to determine if radiographically diagnosed hernias are clinically significant and to define the appropriate role of imaging in diagnosing and assessing abdominal wall defects.