Risk Factors of Long‐Term Incisional Hernia after Open Surgery for Abdominal Aortic Aneurysm: A Bicentric Study

Besancenot, Aurélien; Mont, Lucie Salomon du; Lejay, Anne; Heranney, Julie; Delay, Christophe; Chakfé, Nabil; Rinckenbach, Simon; Thaveau, Fabien

doi:10.1016/j.avsg.2021.10.074

Cited by 8 publications

(2 citation statements)

References 21 publications

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“…Although increased age, obesity, and prior laparotomy are patient-related risk factors for incisional hernia following open surgery (8,9), these factors did not exhibit any significant differences between the groups in this study. Further, chronic obstructive pulmonary disease is another significant risk factor for wound dehiscence (12,13); however, we found no relatable differences between the two groups in this study. Furthermore, Van Rooijen et al have revealed that sarcopenia is not a risk factor for incisional hernia (14), and consistent with this finding, we did not find any differences between the two groups.…”

Section: Discussioncontrasting

confidence: 75%

Risk Factors for Incisional Hernia After Open Abdominal Aortic Aneurysm Repair

ENDO,

MIYAHARA,

SHIRASU

et al. 2023

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Background/Aim: Incisional hernia is among the most prevalent complications associated with open abdominal aortic aneurysm repair. However, risk factors for incisional hernias in patients with abdominal aortic aneurysm are multifactorial. Therefore, this study evaluated the risk factors of incisional hernia after open abdominal aortic aneurysm repair, including surgical factors. Patients and Methods: We retrospectively extracted data from patients with incisional hernias after abdominal aortic aneurysm repair between 2012 and 2019 and investigated their perioperative characteristics and wound closure techniques. Results: The mean follow-up periods were 41.5±30.3 months, and 30 of 131 (22.9%) patients suffered an incisional hernia. Regarding the underlying disease, only diabetes mellitus was significantly more common in the incisional hernia group (11 of 30 patients, 36.6%), and no significant differences were found in the patients' perioperative data. Interrupted sutures were used in all 30 patients in the hernia group. Moreover, in 8 of the 101 remaining cases, barbed sutures were used, and no incisional hernia occurred in any of these cases. Conclusion: In addition to diabetes mellitus, abdominal aortic aneurysm is a significant risk factor for incisional hernia after abdominal aortic aneurysm repair. Therefore, employing the barbed suture technique may effectively prevent incisional hernias after abdominal aortic aneurysm repair.

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Section: Discussioncontrasting

confidence: 75%

Risk Factors for Incisional Hernia After Open Abdominal Aortic Aneurysm Repair

ENDO,

MIYAHARA,

SHIRASU

et al. 2023

In Vivo

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“…Such factors have been employed for risk modeling across a variety of populations. [14][15][16]28,29 Intra-abdominal pressure is a risk factor frequently captured indirectly using perioperative conditions such as COPD 30 and ascites rather than by direct observation such as volumetric or pressure measurements 31 although visceral obesity, when measured, has been identified as correlated with IH formation and IH recurrence. [32][33][34] Our findings support the importance and potential predictive value of visceral volumes and visceral fat volumes, as evidenced by the feature abdominopelvic visceral volume normalized for height, which yielded a predictive accuracy of 0.78, with a sensitivity of 0.74 and specificity of 0.81.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Computed Tomography Morphological Features Indicative of Incisional Hernia Formation After Abdominal Surgery

et al. 2022

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Objective: To investigate key morphometric features identifiable on routine preoperative computed tomography (CT) imaging indicative of incisional hernia (IH) formation following abdominal surgery. Background: IH is a pervasive surgical disease that impacts all surgical disciplines operating in the abdominopelvic region and affecting 13% of patients undergoing abdominal surgery. Despite the significant costs and disability associated with IH, there is an incomplete understanding of the pathophysiology of hernia. Methods: A cohort of patients (n=21,501) that underwent colorectal surgery was identified, and clinical data and demographics were extracted, with a primary outcome of IH. Two datasets of case-control matched pairs were created for feature measurement, classification, and testing. Morphometric linear and volumetric measurements were extracted as features from anonymized preoperative abdominopelvic CT scans. Multivariate Pearson testing was performed to assess correlations among features. Each feature’s ability to discriminate between classes was evaluated using 2-sided paired t testing. A support vector machine was implemented to determine the predictive accuracy of the features individually and in combination. Results: Two hundred and twelve patients were analyzed (106 matched pairs). Of 117 features measured, 21 features were capable of discriminating between IH and non-IH patients. These features are categorized into three key pathophysiologic domains: 1) structural widening of the rectus complex, 2) increased visceral volume, 3) atrophy of abdominopelvic skeletal muscle. Individual prediction accuracy ranged from 0.69 to 0.78 for the top 3 features among 117. Conclusions: Three morphometric domains identifiable on routine preoperative CT imaging were associated with hernia: widening of the rectus complex, increased visceral volume, and body wall skeletal muscle atrophy. This work highlights an innovative pathophysiologic mechanism for IH formation hallmarked by increased intra-abdominal pressure and compromise of the rectus complex and abdominopelvic skeletal musculature.

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