Computed Tomography Image Analysis in Abdominal Wall Reconstruction: A Systematic Review

Abstract

Background: Ventral hernias are a complex and costly burden to the health care system. Although preoperative radiologic imaging is commonly performed, the plethora of anatomic features present and available in routine imaging are seldomly quantified and integrated into patient selection, preoperative risk stratification, and perioperative planning. We herein aimed to critically examine the current state of computed tomography feature application in predicting surgical outcomes. Methods: A systematic review was conducted in accordance with the Preferred Reporting Items for a Systematic Review and Meta-Analysis (PRISMA) checklist. PubMed, MEDLINE, and Embase databases were reviewed under search syntax “computed tomography imaging” and “abdominal hernia” for papers published between 2000 and 2020. Results: Of the initial 1922 studies, 12 papers met inclusion and exclusion criteria. The most frequently used radiologic features were hernia volume (n = 9), subcutaneous fat volume (n = 5), and defect size (n = 8). Outcomes included both complications and need for surgical intervention. Median area under the curve (AUC) and odds ratio were 0.68 (±0.16) and 1.12 (±0.39), respectively. The best predictive feature was hernia neck ratio > 2.5 (AUC 0.903). Conclusions: Computed tomography feature selection offers hernia surgeons an opportunity to identify, quantify, and integrate routinely available morphologic tissue features into preoperative decision-making. Despite being in its early stages, future surgeons and researchers will soon be able to integrate 3D volumetric analysis and complex machine learning and neural network models to improvement patient care.

Technique of Abdominal Wall Tissue Expansion for the Treatment of Massive Complicated Ventral Hernias

“…Preoperatively, computed tomography is used to measure the width of the rectus fascia and the location of the semilunar line (Fig 1). 7 The anticipated incision lines are marked in the preoperative area with the patient in supine position. The patient is asked to flex, gently lift their head, and elevate their legs, with assistance.…”

Computational Analysis and Classification of Hernia Repairs

“…Many of these topics are closely intertwined with the rapid technological advancements in sensor systems, digital cameras, ultrasound methods [11], wireless communication links, material engineering, and 3D printing methods. Computer tomography serves as an efficient visualization tool that can aid in planning ideal hernia repair, particularly for incisional and larger hernias [12][13][14]. This enables hernia surgeons to identify any morphological tissue abnormalities during the preoperative planning phase, enhancing their decision-making capabilities.…”

Computational Intelligence in Hernia Surgery with Classification of Repair Types

“…Many of these topics are closely related to the rapid technological progress of sensor systems, digital cameras, wireless communication links, material engineering and also the progress of 3D printing methods. Computer tomography is an efficient visualization tool that can be used in planning ideal hernia repair in most incisional and larger hernia repairs 10,11 . This allows hernia surgeons to identify all of the morphological tissue disorders in the preoperative planning phase and improves their ability of correct decision-making.…”