Pre-operative CT scan measurements for predicting complications in patients undergoing complex ventral hernia repair using the component separation technique

H Winters,S Hummelink,L Knaapen,O R Buyne,D J O Ulrich,E Van Geffen,H Van Goor,N J Slater

doi:10.1007/s10029-019-01899-8

H Winters, S Hummelink + Show 6 more

Open Access

https://doi.org/10.1007/s10029-019-01899-8

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Abstract

BackgroundThe component separation technique (CST) is considered an excellent technique for complex ventral hernia repair. However, postoperative infectious complications and reherniation rates are significant. Risk factor analysis for postoperative complication and reherniation has focused mostly on patient history and co-morbidity and shows equivocal results. The use of abdominal morphometrics derived from CT scans to assist in risk assessment seems promising. The aim of this study is to determine the predictability of reherniation and surgical site infections (SSI) using pre-operative CT measurements.MethodsElectronic patient records were searched for patients who underwent CST between 2000 and 2013 and had a pre-operative CT scan available. Visceral fat volume (VFV), subcutaneous fat volume (SFV), loss of domain (LOD), rectus thickness and width (RT, RW), abdominal volume, hernia sac volume, total fat volume (TFV), sagittal distance (SD) and waist circumference (WC) were measured or calculated. Relevant variables were entered in multivariate regression analysis to determine their effect on reherniation and SSI as separate outcomes.ResultsSixty-five patients were included. VFV (p = 0.025, OR = 1.65) was a significant predictor regarding reherniation. Hernia sac volume (p = 0.020, OR = 2.10) and SFV per 1000 cm3 (p = 0.034, OR = 0.26) were significant predictors of SSI.ConclusionVisceral fat volume, subcutaneous fat volume and hernia sac volume derived from CT scan measurements may be used to predict reherniation and SSI in patients undergoing complex ventral hernia repair using CST. These findings may aid in optimizing patient-tailored preoperative risk assessment.

Highlights

Complex ventral hernia repair remains a very challenging domain for general and reconstructive surgeons
The aim of the current study is to explore the use of Computed tomography (CT) scan-derived body morphometrics [visceral fat volume (VFV), subcutaneous fat volume (SFV), total fat volume (TFV) and loss of domain (LOD)] to predict reherniation and surgical site infections (SSI) in patients undergoing complex ventral hernia repair using the component separation technique (CST)
We demonstrate that reherniation rate after hernia repair using the CST can be predicted by Visceral fat volume (VFV) measured on a pre-operative CT scan

Summary

Introduction

Complex ventral hernia repair remains a very challenging domain for general and reconstructive surgeons. The component separation technique (CST) is considered an excellent technique to close large complex defects as this procedure reestablishes the abdominal wall integrity In this procedure, the external oblique muscles are released to facilitate the sliding of these myofascial flaps to allow re-approximation of the rectus abdominis [4]. Conclusion Visceral fat volume, subcutaneous fat volume and hernia sac volume derived from CT scan measurements may be used to predict reherniation and SSI in patients undergoing complex ventral hernia repair using CST. These findings may aid in optimizing patient-tailored preoperative risk assessment

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