The value of CT diagnosis of hernia recurrence after prosthetic repair of ventral incisional hernias

Abstract

Herein we present a prospective study made to compare the diagnostic value of a physical examination and a CT scan in the detection of a hernia relapse after carrying out of a intraperitoneal hernioplasty using a non-resorbable mesh. Fifty patients operated on for intraperitoneal hernioplasty with ePTFE mesh and postoperative symptomatology were assessed within a year of the operation via a physical exploration and CT. Each of the patients was subjected to an exploratory laparoscopy for the purpose of confirming the diagnosis. The data were analysed statistically using a chi-square test, sensitivity, specificity, confidence limits, positive predictive value, and negative predictive value. The hernia relapse was correctly diagnosed in 98% of cases by CT and in 88% of cases in the physical examination. The sensitivity was 1 in the CT examination and 0.75 in the physical examination, and the specificity results were 0.97 and 0.90, respectively. The positive predictive value in the CT exam was 0.88, whereas in the physical examination it was 0.60. The negative predictive values were 1 and 0.95, respectively. The differences between the values of both methods held a statistical meaning (chi-square test; p < 0.05). The postoperative assessment by CT of symptomatic patients who have been operated on for an intraperitoneal hernioplasty with unabsorbable mesh facilitates carrying out a correct diagnosis in the detection or exclusion of hernial relapse.

Reoperation Versus Clinical Recurrence Rate After Ventral Hernia Repair

“…Nevertheless, the clinical examination might have ignored some recurrences especially in obese patients and even caused false-positive findings, which could have been verified if patients routinely had a CT-scan, ultrasonography, or even better a diagnostic laparoscopy. 24 However, the influences of these drawbacks are probably low because patients with uncertain clinical examination underwent additional imaging (CT or ultrasound). The use of invasive laparoscopy in nonsymptomatic hernia recurrences was considered unethical.…”

PREBIOUS trial: A multicenter randomized controlled trial of PREventive midline laparotomy closure with a BIOabsorbable mesh for the prevention of incisional hernia: Rationale and design

“…In the experience of other authors, abdominal CT is useful in the diagnosis of occult incisional hernias [46], particularly multi-detector row CT because it provides exquisite anatomic detail of the abdominal wall [47] The diagnostic accuracy of CT was also significantly higher than that of physical examination in the detection of hernia relapse within a year of operation of symptomatic patients who have been operated on for an intraperitoneal hernioplasty with unabsorbable mesh [48].…”

Multidetector CT of expected findings and early postoperative complications after current techniques for ventral hernia repair

“…In the vast majority of cases, hernia recurrence is reliably identified using CT (Figs. 13 and 14 ) [ 7 ].

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“…Owing to the vast number of open and laparoscopic interventions performed each year at most general hospitals, radiologists may be confronted with urgent requests to investigate suspected iatrogenic injuries. However, the radiological reports on this subject that are currently available are mostly focused on the normal imaging appearance of prosthetic meshes (PMs), the occurrence and fate of common post-surgical seromas [ 5 , 6 ], the value of computed tomography (CT) for diagnosis of recurrent hernias [ 7 ], and complications secondary to laparoscopic access for different surgical procedures [ 8 ].…”