Preoperative CT imaging as a tool to predict incisional hernia outcomes following abdominal wall reconstruction: A retrospective cohort analysis.

Autor: Frommer ML; Charles Wolfson Centre for Reconstructive Surgery, Royal Free Hospital, London NW3 2QG, United Kingdom; Division of Surgery & Interventional Science, University College London, London NW3 2QG, United Kingdom; Department of Plastic Surgery, Royal Free Hospital, London NW3 2QG, United Kingdom. Electronic address: marvin.frommer.21@ucl.ac.uk., Faderani R; Department of Plastic Surgery, Royal Free Hospital, London NW3 2QG, United Kingdom., Kanapathy M; Division of Surgery & Interventional Science, University College London, London NW3 2QG, United Kingdom; Department of Plastic Surgery, Royal Free Hospital, London NW3 2QG, United Kingdom., Pérusseau-Lambert A; Division of Surgery & Interventional Science, University College London, London NW3 2QG, United Kingdom., Shankar A; The Lister Hospital, London, London SW1W 8RH, United Kingdom., Malhotra A; Department of Radiology, Royal Free Hospital, London NW3 2QG, United Kingdom., Khosh Zaban M; Department of Radiology, Royal Free Hospital, London NW3 2QG, United Kingdom., Floyd D; Division of Surgery & Interventional Science, University College London, London NW3 2QG, United Kingdom; Department of Plastic Surgery, Royal Free Hospital, London NW3 2QG, United Kingdom., Butler PEM; Charles Wolfson Centre for Reconstructive Surgery, Royal Free Hospital, London NW3 2QG, United Kingdom; Division of Surgery & Interventional Science, University College London, London NW3 2QG, United Kingdom; Department of Plastic Surgery, Royal Free Hospital, London NW3 2QG, United Kingdom., Ghali S; Division of Surgery & Interventional Science, University College London, London NW3 2QG, United Kingdom; Department of Plastic Surgery, Royal Free Hospital, London NW3 2QG, United Kingdom.
Jazyk: angličtina
Zdroj: Journal of plastic, reconstructive & aesthetic surgery : JPRAS [J Plast Reconstr Aesthet Surg] 2024 Jan; Vol. 88, pp. 369-377. Date of Electronic Publication: 2023 Nov 11.
DOI: 10.1016/j.bjps.2023.11.007
Abstrakt: Introduction: Ventral wall hernia often causes significant morbidity and requires complex abdominal wall reconstruction (AWR). This study aims to determine whether subcutaneous abdominal fat thickness (AFT) measured with preoperative CT scans could predict postoperative outcomes in patients undergoing AWR.
Methods: A retrospective cohort study was conducted on all patients who underwent AWR at our institution between 2009 and 2021, with a minimum follow-up of 12 months. Using preoperative CT scans, AFT was measured at the xiphoid process, umbilicus, and pubic tubercle, as well as the hernia dimensions. Demographic, operative, and surgical outcome data were also collected and analyzed using statistical tests.
Results: The results showed that 9 of 101 patients (8.9%) experienced hernia recurrence. Smoking was associated with an increased risk of hernia recurrence (p < 0.001) with a predictive odds ratio (OR) of 18.27 (p = 0.041). Increased AFT at the xiphoid (p = 0.005), umbilicus (p < 0.001), and pubic tubercle (p < 0.001) were also associated with hernia recurrence and risk of infection. Only AFT at the pubic tubercle reached significance in the regression model predicting recurrence (OR=1.10; p = 0.030) and infection (OR=1.04; p = 0.021). A cut-off value of 67 mm was associated with a positive predictive value of 42.14% (sensitivity of 67% and specificity of 91%). Hernia defect area was not associated with risk of recurrence or infection.
Conclusions: Smoking and increased AFT at the pubic tubercle are significant predictive factors for recurrence and infection in patients undergoing AWR, and preoperative optimization should focus on reducing these factors.
Competing Interests: Declaration of Competing Interest MLF, RF, APL, AS, MK, AM, MKZ, DF, PEMB, and SG have nothing to report. All declared interests are outside of the submitted work.
(Copyright © 2023 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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