Computed tomography imaging in ventral hernia repair: can we predict the need for myofascial release?

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

“…Christy et al demonstrated the efficacy of a novel component separation index in preoperatively predicting the difficulty of achieving fascial closure 27 Similarly, Love et al demonstrated that the rectus width to hernia width ratio is a practical, reliable tool to predict the ability to close during Rives–Stoppa repair without abdominal muscle release. 11 In large IHs with loss of domain, volume to peritoneal volume ratio of <20% was predictive of tension-free fascial closure. 14 The software used to calculate volumes in this study was specialized with limited accessibility.…”

“…Eight of 12 studies were of “good” quality, receiving a total score of at least 6 of 8 across all domains. 11 , 14 – 20 The remaining 4 studies were of “poor” quality due to no comparative analysis built into the study design. 6 , 21 – 23 No study had a total score < 4.…”

“… 10 Presurgical planning that incorporates information from imaging simultaneously aids the surgeon in identifying the optimal repair technique and informs patient counseling. 11 To further bolster these efforts to utilize preoperative imaging to improve surgical planning and patient care, our study aimed to systematically review the literature on publications evaluating the use preoperative CT features associated with perioperative ventral hernia outcomes. We theorize that the utilization of morphologic CT features will improve patient selection, perioperative decision-making, and postoperative complications.…”

New perspectives in abdominal wall reconstruction: posterior component separation/transversus abdominis release

“…As stated previously, the concern in performing a TAR after ACS centers on the potential for lateral hernia formation. Previous evaluation of TAR after EO release resulted in hernia recurrence in only 3% of patients after 11-month follow-up, suggesting the method may be utilized successfully in experienced hands [12] .…”

“…However, TAR may be required if a classic Rives-Stoppa is unable to achieve midline closure, when there is insufficient mesh coverage behind the rectus muscle or in the following settings: large defects, multiply recurrent hernias, non-compliant abdominal walls necessitating myofascial release, and parastomal hernias. Although it is hard to definitively predict preoperatively which patients will require a TAR in addition to a Rives-Stoppa repair, Love et al [12] hypothesized that Rives-Stoppa repair will achieve midline closure if the sum of the rectus widths is twice the width of the defect width when measured on CT scan. The authors recommend that previous subcutaneous or wound related complications should be approached with TAR rather than open ACS.…”