Application value of the preoperative multi-slice spiral computed tomography for the repair of huge abdominal incisional hernia

Abstract

Objective To explore the application value of the preoperative multi-slice spiral computed tomography (MSCT) for the repair of huge abdominal incisional hernia. Methods The retrospective cross-sectional study was conducted. The clinical data of 61 patients with huge abdominal incisional hernia who were admitted to the Xinjiang Uygur Autonomous Region People′s Hospital from January 2012 to February 2016 were collected. All patients underwent preoperative MSCT and three-dimensional reconstruction to measure the percentage of volumes of the hernia sac and abdominal cavity and then selected the individualized surgical methods according to the percentage, and length of small intestine resected was calculated in patients undergoing initiative volume reduction combined with onlay repair. Observation indicators: (1) pre- and post-operative situations: percentage of volumes of the hernia sac and abdominal cavity, duration of preoperative hospital stay, surgical procedure, length of small intestine resected in patients undergoing initiative volume reduction combined with onlay repair, operation time and volume of intraoperative blood loss; (2) postoperative recovery situation: intra-abdominal pressure at postoperative 48 hours, recovery time of postoperative gastrointestinal function, removal time of postoperative abdominal drainage-tube, postoperative complications and duration of postoperative hospital stay; (3) follow-up. Follow-up using outpatient examination and telephone interview was performed to detect the postoperative hernia recurrence and long-term complications up to March 2017. Measurement data with normal distribution were represented as ±s and measurement data with skewed distribution were described as M (range). Results (1) Pre- and post-operative situations: percentage of volumes of the hernia sac and abdominal cavity in 61 patients was 19%±4%, and duration of preoperative hospital stay was (7±5)days. All the 61 patients underwent successful operation, including 48 receiving onlay repair and 13 receiving initiative volume reduction combined with onlay repair, without conversion to other surgery. Length of small intestine resected in 13 patients undergoing initiative volume reduction combined with onlay repair was (48±8)cm. Operation time and volume of intraoperative blood loss in 61 patients were (2.6±0.8)hours and (82±50)mL. (2) Postoperative recovery situation: intra-abdominal pressure at postoperative 48 hours, recovery time of postoperative gastrointestinal function and removal time of postoperative abdominal drainage-tube in 61 patients were (9.6±2.9)mmHg (1 mmHg=0.133kPa), (2.1±0.9)days and (3.5±1.1)days, respectively. Twelve patients had postoperative complications, and grade Ⅰ intra-abdominal hypertension, grade Ⅱ intra-abdominal hypertension, incisional effusion, incisional infection, incisional sinus, mesh infection and urinary retention were respectively detected in 4, 2, 4, 2, 1, 1, 1 in patients undergoing the onlay repair and 2, 1, 1, 0, 0, 0, 0 in patients undergoing initiative volume reduction combined with onlay repair. Some patients had 2 or more of complications. There was no occurrence of abdominal compartment syndrome and perioperative death. Patients with complications were cured or improved by symptomatic treatment. Duration of postoperative hospital stay in 61 patients was (8±4)days. (3) Follow-up: all the patients were followed up for 6-36 months, with a median time of 19 months. During follow-up, 2 patients with recurrence of huge abdominal incisional hernia received tentative follow-up, and were suggested to treat risk factors of recurrence firstly and then undergo reoperations. Other patients didn′t have long-term complications. Conclusion MSCT can provide the accurate data of percentage of volumes of the hernia sac and abdominal cavity before repair of huge abdominal incisional hernia, it also has the important clinical value of choosing the individualized surgical method, preserving the maximum out of normal organs in initiative volume reduction combined with onlay repair and increasing surgical outcomes. Key words: Abdominal incisional hernia, huge; Hernia repair; Multiplanar reconstruction; Tomography