Abstract
ObjectiveWe described and validated a quantitative anatomical labeling protocol for extracting clinically relevant quantitative parameters for ventral hernias (VH) from routine computed tomography (CT) scans. This information was then used to predict the need for mesh bridge closure during ventral hernia repair (VHR).MethodsA detailed anatomical labeling protocol was proposed to enable quantitative description of VH including shape, location, and surrounding environment (61 scans). Intra- and inter-rater reproducibilities were calculated for labeling on 18 and 10 clinically acquired CT scans, respectively. Preliminary clinical validation was performed by correlating 20 quantitative parameters derived from anatomical labeling with the requirement for mesh bridge closure at surgery (26 scans). Prediction of this clinical endpoint was compared with similar models fit on metrics from the semi-quantitative European Hernia Society Classification for Ventral Hernia (EHSCVH).ResultsHigh labeling reproducibilities were achieved for abdominal walls (±2 mm in mean surface distance), key anatomical landmarks (±5 mm in point distance), and hernia volumes (0.8 in Cohen’s kappa). 9 out of 20 individual quantitative parameters of hernia properties were significantly different between patients who required mesh bridge closure versus those in whom fascial closure was achieved at the time of VHR (p<0.05). Regression models constructed by two to five metrics presented a prediction with 84.6% accuracy for bridge requirement with cross-validation; similar models constructed by EHSCVH variables yielded 76.9% accuracy.SignificanceReproducibility was acceptable for this first formal presentation of a quantitative image labeling protocol for VH on abdominal CT. Labeling-derived metrics presented better prediction of the need for mesh bridge closure than the EHSCVH metrics. This effort is intended as the foundation for future outcomes studies attempting to optimize choice of surgical technique across different anatomical types of VH.
Highlights
Ventral abdominal hernia (VH) repair is one of the most commonly performed general surgery procedures worldwide
High labeling reproducibilities were achieved for abdominal walls (±2 mm in mean surface distance), key anatomical landmarks (±5 mm in point distance), and hernia volumes (0.8 in Cohen’s kappa). 9 out of 20 individual quantitative parameters of hernia properties were significantly different between patients who required mesh bridge closure versus those in whom fascial closure was achieved at the time of ventral hernia repair (VHR) (p
Regression models constructed by two to five metrics presented a prediction with 84.6% accuracy for bridge requirement with cross-validation; similar models constructed by European Hernia Society Classification for Ventral Hernia (EHSCVH) variables yielded 76.9% accuracy
Summary
Ventral abdominal hernia (VH) repair is one of the most commonly performed general surgery procedures worldwide. Multiple factors impact the success of VH repair These factors include preoperative conditions (e.g., obesity, nicotine use, previous infections), hernia characteristics, operative technique and perioperative care (e.g., perioperative antibiotics, operative time). The most well-known VH classification system is the European Hernia Society Classification for Ventral Hernia (EHSCVH) [5]. The Ventral Hernia Working Group (VHWG) proposed a hernia grading system to access patients’ risk for surgical-site occurrences based on more comprehensive clinical factors of patients and wounds [6]; this classification system and its variant [7] are not commonly used given that the involved factors are complicated to access. We hypothesize that a quantitative imaging approach will provide a more objective, efficient, and reproducible means of describing VH, and that this approach may inform future evidence-based research to improve VH repair outcomes
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