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Alvarez-Lozada LA, Arrambide-Garza FJ, Quiroga-Garza A, Huerta-Sanchez MC, Escobar-Luna A, Sada-Treviño MA, Ramos-Proaño CE, Elizondo-Omaña RE. Underdiagnosis of umbilical hernias in CT scans in a multicenter study - the radiologically neglected pathology and its surgical implications. Hernia 2024:10.1007/s10029-024-03079-9. [PMID: 38837076 DOI: 10.1007/s10029-024-03079-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 05/19/2024] [Indexed: 06/06/2024]
Abstract
PURPOSE Umbilical hernias (UH) have a higher prevalence than previously considered. With the high workload radiologists must endure, UH can be missed when interpreting a computed tomography scan (CT). The clinical implications of its misdiagnosis are yet to be determined. Unreporting could lead to content lesions in surgical approaches and other potential complications. The aim was to determine the prevalence of UH using CT scans, and the incidence of radiological reporting. METHODS A multicenter, cross-sectional study was performed in four tertiary-level hospitals. CT scans were reviewed for abdominal wall defects at the umbilicus, and radiological reports were examined to compare findings. In the case of UH, transversal, anteroposterior, and craniocaudal lengths were obtained. RESULTS A total of 1557 CTs were included, from which 971 (62.4%, 95% CI 0.59-0.64) had UH. Out of those, 629 (64.8%, 95% CI 0.61-0.67) of the defects were not included in the radiological report. Smaller UH (x̄: 7.7 × 6.0 mm) were more frequently missed. Of the reported UH, 187 (54.7%) included at least one axis measurement, 289 (84.5%) content description, and 146 (42.7%) whether or not there were complication signs. CONCLUSION There is a high prevalence of UH, and a high incidence of under-reporting. This raises the question of whether this is a population-based finding or the norm worldwide. The reason of under-reporting and the clinical implications of these must be addressed in further studies.
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Affiliation(s)
- Luis Adrian Alvarez-Lozada
- Clinical-Surgical Research Group (GICQx), Human Anatomy Research Group (GIA), Human Anatomy Department, School of Medicine, Universidad Autonoma de Nuevo Leon, Francisco I. Madero y Aguirre Pequeño sin número, Colonia Mitras Centro, Monterrey, Monterrey, Nuevo León, C.P. 64460, México
| | - Francisco Javier Arrambide-Garza
- Clinical-Surgical Research Group (GICQx), Human Anatomy Research Group (GIA), Human Anatomy Department, School of Medicine, Universidad Autonoma de Nuevo Leon, Francisco I. Madero y Aguirre Pequeño sin número, Colonia Mitras Centro, Monterrey, Monterrey, Nuevo León, C.P. 64460, México
| | - Alejandro Quiroga-Garza
- Clinical-Surgical Research Group (GICQx), Human Anatomy Research Group (GIA), Human Anatomy Department, School of Medicine, Universidad Autonoma de Nuevo Leon, Francisco I. Madero y Aguirre Pequeño sin número, Colonia Mitras Centro, Monterrey, Monterrey, Nuevo León, C.P. 64460, México.
- Servicio de Cirugía General, Hospital de Traumatología y Ortopedia No.21, Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon, Mexico.
| | - Monica Catalina Huerta-Sanchez
- Department of Radiology, School of Medicine, Universidad Autonoma de Nuevo Leon, University Hospital "Dr. Jose Eleuterio Gonzalez", Monterrey, Mexico
| | - Ana Escobar-Luna
- Department of Radiology, Instituto Tecnológico y de Estudios Superiores de Monterrey, Hospital San José Tec Salud, Monterrey, Mexico
| | | | - Carlos Enrique Ramos-Proaño
- Department of Radiology, Instituto Tecnológico y de Estudios Superiores de Monterrey, Hospital San José Tec Salud, Monterrey, Mexico
| | - Rodrigo Enrique Elizondo-Omaña
- Clinical-Surgical Research Group (GICQx), Human Anatomy Research Group (GIA), Human Anatomy Department, School of Medicine, Universidad Autonoma de Nuevo Leon, Francisco I. Madero y Aguirre Pequeño sin número, Colonia Mitras Centro, Monterrey, Monterrey, Nuevo León, C.P. 64460, México.
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Olavarria OA, Lyons NB, Bernardi K, Dhanani NH, Neela N, Arakelians A, Cohen BL, Mohebzad K, Coelho R, Holihan JL, Liang MK. Impact of disclosure of radiographic test results on quality of life among patients with hernias: a randomized controlled trial. Hernia 2024; 28:411-418. [PMID: 37369887 DOI: 10.1007/s10029-023-02824-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 06/10/2023] [Indexed: 06/29/2023]
Abstract
PURPOSE Hernias noted on radiographic imaging are common. We aimed to determine if informing patients of the presence of a clinically apparent or occult hernia on imaging would change their abdominal wall quality of life (AW-QOL). METHODS This study was registered on clinicaltrials.gov (NCT04355819) in April 2020. Patients with a ventral hernia on elective CT abdomen/pelvis were enrolled. Patients underwent standardized abdominal examination by surgeons, and completed the modified Activities Assessment Scale, a validated, hernia-specific AW-QOL survey. On this scale, 1 is poor AW-QOL, 100 is perfect, and the minimally clinically important difference is five for a minor change. Patients were randomized to complete the one-year follow-up survey before or after being informed of the presence of a hernia on their imaging results. Primary outcome was follow-up AW-QOL adjusted for baseline AW-QOL. RESULTS Of 169 patients randomized, 126 (75%) completed follow up at one-year. Among patients with occult hernias, those who completed the follow-up survey after being informed of having a hernia had a lower follow-up AW-QOL (mean difference - 7.6, 95% CI = - 20.8 to 5.7, p = 0.261) compared to those who completed the survey before being informed. Conversely, for patients with clinical hernias, those who completed the survey after being informed had higher adjusted follow-up AW-QOL (mean difference 10.3, 95% CI = - 3.0 to 23.6, p = 0.126) than those that completed it after. CONCLUSION Conveying findings of hernias found on CT imaging can influence patients' AW-QOL. Future research should focus on identifying and addressing patients' concerns after disclosure of CT results.
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Affiliation(s)
- O A Olavarria
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center Houston, Houston, TX, USA
- Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA
| | - N B Lyons
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
- Ryder Trauma Center, Suite T-215, 1800 NW 10Th Ave, Miami, FL, 33136, USA.
| | - K Bernardi
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center Houston, Houston, TX, USA
- Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA
| | - N H Dhanani
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center Houston, Houston, TX, USA
- Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA
| | - N Neela
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center Houston, Houston, TX, USA
| | - A Arakelians
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - B L Cohen
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
- Ryder Trauma Center, Suite T-215, 1800 NW 10Th Ave, Miami, FL, 33136, USA
| | - K Mohebzad
- Department of Surgery, University of Houston, HCA Kingwood, Kingwood, TX, USA
| | - R Coelho
- Department of Surgery, University of Houston, HCA Kingwood, Kingwood, TX, USA
| | - J L Holihan
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center Houston, Houston, TX, USA
- Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA
| | - M K Liang
- Department of Surgery, University of Houston, HCA Kingwood, Kingwood, TX, USA
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Alvarez-Lozada LA, Ramos-Morales PE, Elizondo-Omaña RE, Quiroga-Garza A. Comment to: Impact of disclosure of radiographic test results on quality of life among patients with hernias. Hernia 2024; 28:653-654. [PMID: 37682376 DOI: 10.1007/s10029-023-02869-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 08/20/2023] [Indexed: 09/09/2023]
Affiliation(s)
- L A Alvarez-Lozada
- School of Medicine, Human Anatomy Department, Clinical-Surgical Research Group (GICQx), Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - P E Ramos-Morales
- School of Medicine, Human Anatomy Department, Clinical-Surgical Research Group (GICQx), Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - R E Elizondo-Omaña
- School of Medicine, Human Anatomy Department, Clinical-Surgical Research Group (GICQx), Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - A Quiroga-Garza
- School of Medicine, Human Anatomy Department, Clinical-Surgical Research Group (GICQx), Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico.
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LaGuardia JS, Milek D, Lebens RS, Chen DR, Moghadam S, Loria A, Langstein HN, Fleming FJ, Leckenby JI. A Scoping Review of Quality-of-Life Assessments Employed in Abdominal Wall Reconstruction. J Surg Res 2024; 295:240-252. [PMID: 38041903 DOI: 10.1016/j.jss.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 09/08/2023] [Accepted: 10/27/2023] [Indexed: 12/04/2023]
Abstract
INTRODUCTION Surgeons use several quality-of-life instruments to track outcomes following abdominal wall reconstruction (AWR); however, there is no universally agreed upon instrument. We review the instruments used in AWR and report their utilization trends within the literature. METHODS This scoping review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for Scoping Reviews guidelines using the PubMed, Embase, Web of Science, ClinicalTrials.gov, and Cochrane databases. All published articles in the English language that employed a quality-of-life assessment for abdominal wall hernia repair were included. Studies which focused solely on aesthetic abdominoplasty, autologous breast reconstruction, rectus diastasis, pediatric patients, inguinal hernia, or femoral hernias were excluded. RESULTS Six hernia-specific tools and six generic health tools were identified. The Hernia-Related Quality-of-Life Survey and Carolinas Comfort Scale are the most common hernia-specific tools, while the Short-Form 36 (SF-36) is the most common generic health tool. Notably, the SF-36 is also the most widely used tool for AWR outcomes overall. Each tool captures a unique set of patient outcomes which ranges from abdominal wall functionality to mental health. CONCLUSIONS The outcomes of AWR have been widely studied with several different assessments proposed and used over the past few decades. These instruments allow for patient assessment of pain, quality of life, functional status, and mental health. Commonly used tools include the Hernia-Related Quality-of-Life Survey, Carolinas Comfort Scale, and SF-36. Due to the large heterogeneity of available instruments, future work may seek to determine or develop a standardized instrument for characterizing AWR outcomes.
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Affiliation(s)
- Jonnby S LaGuardia
- Department of Plastic and Reconstructive Surgery, University of Rochester Medical Center, Rochester, New York.
| | - David Milek
- Department of Plastic and Reconstructive Surgery, University of Rochester Medical Center, Rochester, New York
| | - Ryan S Lebens
- Department of Plastic and Reconstructive Surgery, University of Rochester Medical Center, Rochester, New York
| | - David R Chen
- Department of Plastic and Reconstructive Surgery, University of Rochester Medical Center, Rochester, New York
| | - Shahrzad Moghadam
- Department of Plastic and Reconstructive Surgery, University of Rochester Medical Center, Rochester, New York
| | - Anthony Loria
- Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Howard N Langstein
- Department of Plastic and Reconstructive Surgery, University of Rochester Medical Center, Rochester, New York
| | - Fergal J Fleming
- Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Jonathan I Leckenby
- Department of Plastic and Reconstructive Surgery, University of Rochester Medical Center, Rochester, New York
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Quach D, Lyons NB, Nguyen K, Olavarria OA, Bernardi K, Neela N, Dhanani NH, Jackson A, Ali Z, Liang MK. Natural history of occult hernias in adults at a safety-net hospital. Hernia 2023; 27:1467-1472. [PMID: 36795186 DOI: 10.1007/s10029-023-02754-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 02/03/2023] [Indexed: 02/17/2023]
Abstract
PURPOSE Occult hernias, hernias seen on radiologic imaging but not felt on physical exam, are common. Despite their high prevalence, little is known about the natural history of this finding. Our aim was to determine and report on the natural history of patients with occult hernias including the impact on abdominal wall quality of life (AW-QOL), need for surgery, and risk of acute incarceration/strangulation. METHODS This was a prospective cohort study of patients who underwent a computed tomography (CT) abdomen/pelvis scan from 2016 to 2018. Primary outcome was change in AW-QOL using the modified Activities Assessment Scale (mAAS), a hernia-specific, validated survey (1 = poor, 100 = perfect). Secondary outcomes included elective and emergent hernia repairs. RESULTS A total of 131 (65.8%) patients with occult hernias completed follow-up with a median (IQR) of 15.4 (22.5) months. Nearly half of these patients (42.8%) experienced a decrease in their AW-QOL, 26.0% were unchanged, and 31.3% reported improvement. One-fourth of patients (27.5%) underwent abdominal surgery during the study period: 9.9% were abdominal procedures without hernia repair, 16.0% involved elective hernia repairs, and 1.5% were emergent hernia repairs. AW-QOL improved for patients who underwent hernia repair (+ 11.2 ± 39.7, p = 0.043) while those who did not undergo hernia repair experienced no change in AW-QOL (- 3.0 ± 35.1). CONCLUSION When untreated, patients with occult hernias on average experience no change in their AW-QOL. However, many patients experience improvement in AW-QOL after hernia repair. Additionally, occult hernias have a small but real risk of incarceration requiring emergent repair. Further research is needed to develop tailored treatment strategies.
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Affiliation(s)
- D Quach
- Department of Surgery, HCA Healthcare Kingwood, University of Houston, Kingwood, TX, USA
| | - N B Lyons
- Department of Surgery, University of Miami Miller School of Medicine, 1800 NW 10th Ave, Miami, FL, 33136, USA.
| | - K Nguyen
- Department of Surgery, HCA Healthcare Kingwood, University of Houston, Kingwood, TX, USA
| | - O A Olavarria
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA
| | - K Bernardi
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA
| | - N Neela
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - N H Dhanani
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA
| | - A Jackson
- Department of Surgery, University of Miami Miller School of Medicine, 1800 NW 10th Ave, Miami, FL, 33136, USA
| | - Z Ali
- Department of Surgery, HCA Healthcare Kingwood, University of Houston, Kingwood, TX, USA
| | - M K Liang
- Department of Surgery, HCA Healthcare Kingwood, University of Houston, Kingwood, TX, USA
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Buyukozsoy AK, Karatay E, Gok MA. Comparison of the Effectiveness of Ultrasound Imaging and Perioperative Measurement in the Diagnosis and Characterization of Incisional Hernia. J Med Ultrasound 2023; 31:35-39. [PMID: 37180619 PMCID: PMC10173835 DOI: 10.4103/jmu.jmu_189_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/20/2021] [Accepted: 03/14/2022] [Indexed: 05/16/2023] Open
Abstract
Background Incisional hernia (IH) is a common complication after abdominal surgery, and there is no gold standard imaging modality for its diagnosis. Although computed tomography is frequently used in clinical practice, it has limitations such as radiation exposure and relatively high cost. The aim of this study is to establish standardization and hernia typing by comparing preoperative ultrasound (US) measurements and perioperative measurements in IH cases. Methods The patients who were operated for IH in our institution between January 2020 and March 2021 were reviewed, retrospectively. In result, 120 patients were included in the study, and the cases had preoperative US images and perioperative hernia measurements. IH was divided into three subtypes as omentum (Type I), intestinal (Type II), and mixed (Type III) according to the defect content. Results Type I IH was detected in 91 cases, Type II IH in 14 cases, and Type III IH in 15 cases. When the diameters of IH types were compared for preoperative US and perioperative measurements, respectively, there was no statistical significance (P = 0.185 and P = 0.262). According to Spearman correlation, there was a positive very strong correlation between preoperative US measurements and perioperative measurements (ρ = 0.861 and P < 0.001). Conclusion As stated by our results, US imaging can be performed easily and quickly, providing a reliable way to accurately detect and characterize an IH. It can also facilitate the planning of surgical intervention in IH by providing anatomical information.
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Affiliation(s)
| | - Emrah Karatay
- Department of Radiology, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
- Address for correspondence: Dr. Emrah Karatay, Department of Radiology, Marmara University Pendik Training and Research Hospital, Fevzi Çakmak, Muhsin Yazıcıoğlu Cd No: 10 Pendik, 34899, Istanbul, Turkey. E-mail:
| | - Mehmet Ali Gok
- Department of General Surgery, Istanbul Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
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Olavarria OA, Dhanani NH, Bernardi K, Holihan JL, Bell CS, Ko TC, Liang MK. Prophylactic Mesh Reinforcement for Prevention of Midline Incisional Hernias: A Publication Bias Adjusted Meta-analysis. Ann Surg 2023; 277:e162-e169. [PMID: 33630465 DOI: 10.1097/sla.0000000000004729] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To systematically review the published literature on the use of prophylactic mesh reinforcement of midline laparotomy closures for prevention of VIH. SUMMARY OF BACKGROUND DATA VIH are common complications of abdominal surgery. Prophylactic mesh has been proposed as an adjunct to prevent their occurrence. METHODS PubMed, Embase, Scopus, and Cochrane were reviewed for RCTs that compared prophylactic mesh reinforcement versus conventional suture closure of midline abdominal surgery. Primary outcome was the incidence of VIH at postoperative follow-up ≥24 months. Secondary outcomes included surgical site infection and surgical site occurrence (SSO). Pooled risk ratios were obtained through random effect meta-analyses and adjusted for publication bias. Network meta-analyses were performed to compare mesh types and locations. RESULTS Of 1969 screened articles, 12 RCTs were included. On meta-analysis there was a lower incidence of VIH with prophylactic mesh [11.1% vs 21.3%, Relative risk (RR) = 0.32; 95% confidence interval (CI) = 0.19-0.55, P < 0.001), however, publication bias was highly likely. When adjusted for this bias, prophylactic mesh had a more conservative effect (RR = 0.52; 95% CI = 0.39-0.70). There was no difference in risk of surgical site infection (9.1% vs 8.9%, RR = 1.08, 95% CI = 0.82-1.43; P = 0.118), however, prophylactic mesh increased the risk of SSO (14.2% vs 8.9%, RR = 1.57, 95% CI = 1.19-2.05; P < 0.001). CONCLUSION Current RCTs suggest that in mid-term follow-up prophylactic mesh prevents VIH with increased risk for SSO. There is limited long-term data and substantial publication bias.
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Affiliation(s)
- Oscar A Olavarria
- Department of Surgery, Lyndon B. Johnson General Hospital, McGovern Medical School at UTHealth, Houston, Texas
- Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School at UTHealth, Houston, Texas
| | - Naila H Dhanani
- Department of Surgery, Lyndon B. Johnson General Hospital, McGovern Medical School at UTHealth, Houston, Texas
- Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School at UTHealth, Houston, Texas
| | - Karla Bernardi
- Department of Surgery, Lyndon B. Johnson General Hospital, McGovern Medical School at UTHealth, Houston, Texas
- Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School at UTHealth, Houston, Texas
| | - Julie L Holihan
- Department of Surgery, Lyndon B. Johnson General Hospital, McGovern Medical School at UTHealth, Houston, Texas
- Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School at UTHealth, Houston, Texas
| | - Cynthia S Bell
- Department of Pediatrics, McGovern Medical School at UTHealth, Houston, TX
- Center for Clinical Research and Evidence Based Medicine, McGovern Medical School at UTHealth, Houston, Texas
| | - Tien C Ko
- Department of Surgery, Lyndon B. Johnson General Hospital, McGovern Medical School at UTHealth, Houston, Texas
| | - Mike K Liang
- Department of Surgery, Lyndon B. Johnson General Hospital, McGovern Medical School at UTHealth, Houston, Texas
- Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School at UTHealth, Houston, Texas
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Garcia EM, Pietryga JA, Kim DH, Fowler KJ, Chang KJ, Kambadakone AR, Korngold EK, Liu PS, Marin D, Moreno CC, Panait L, Santillan CS, Weinstein S, Wright CL, Zreloff J, Carucci LR. ACR Appropriateness Criteria® Hernia. J Am Coll Radiol 2022; 19:S329-S340. [PMID: 36436960 DOI: 10.1016/j.jacr.2022.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/07/2022] [Indexed: 11/27/2022]
Abstract
Abdominopelvic hernias are common clinical entities composed of a wide variety of congenital, traumatic, and iatrogenic etiologies. Any weakness in the body wall may result in hernia of cavity contents with concomitant risks of morbidity and mortality. Presentations may be specific, palpable body wall mass/bulge, or vague, nonspecific pain through bowel obstruction. This document focuses on initial imaging of the adult population with signs of symptoms prompting suspicion of abdominopelvic hernia. Imaging of the abdomen and pelvis to evaluate defects is essential for prompt diagnosis and treatment. Often CT and ultrasound are the first-line modalities to quickly evaluate the abdomen and pelvis, providing for accurate diagnoses and management of patients. MRI protocols may be useful as first-line imaging studies, especially in patients with orthopedic instrumentation. Although often performed, abdominal radiographs and fluorographic procedures may provide indirect evidence of hernias but are usually not indicated for initial diagnosis of hernia. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer-reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer-reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Evelyn M Garcia
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia; Board Member, Taubman Museum of Art.
| | - Jason A Pietryga
- Division Chief, Emergency Radiology at UNC Chapel Hill, Chapel Hill North Carolina; and University of Alabama at Birmingham, Birmingham, Alabama
| | - David H Kim
- Panel Chair, University of Wisconsin Hospital & Clinics, Madison, Wisconsin; and Vice-Chair of Education, University of Wisconsin Department of Radiology
| | - Kathryn J Fowler
- Panel Vice-Chair, University of California San Diego, San Diego, California; Chair ACR LI-RADS; Division Chief, SAR Portfolio Director, RSNA Radiology Senior Deputy Editor
| | - Kevin J Chang
- Boston University Medical Center, Boston, Massachusetts; Section Chief of Abdominal Imaging, Director of MRI, Chair of Committee on C-RADS
| | - Avinash R Kambadakone
- Massachusetts General Hospital, Boston, Massachusetts; Division Chief, Abdominal Imaging, Massachusetts General Hospital and Medical Director, Martha's Vineyard Hospital Imaging
| | - Elena K Korngold
- Section Chief, Body Imaging/Chair, Department of Radiology Promotion and Tenure Committee; Oregon Health and Science University, Portland, Oregon
| | - Peter S Liu
- Section Head, Abdominal Imaging, Cleveland Clinic, Cleveland, Ohio
| | - Daniele Marin
- Duke University Medical Center, Durham, North Carolina
| | | | - Lucian Panait
- President, Minnesota Hernia Center, Minneapolis, Minnesota; American College of Surgeons; American Hernia Society (member of the Technology and Value Assessment Committee); Practice Advisory Committee Member, American Hernia Society
| | - Cynthia S Santillan
- Vice-Chair of Clinical Operations, Department of Radiology, University of California San Diego, San Diego, California
| | | | | | - Jennifer Zreloff
- Georgia, Primary Care Physician, Emory University, Atlanta, Georiga; Medical Director, Seavey General Medicine Clinic; Assistant Director of Innovation Seavey Comprehensive Internal Medicine Clinic, Emory University, Atlanta, Georgia
| | - Laura R Carucci
- Specialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia; Section Chief Abdominal Imaging, Director of MRI and CT
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Wilson MZ. We Asked the Experts: Repair Techniques as Prevention: Ostomy Closure is an Incisional Hernia Repair. World J Surg 2022; 46:1896-1897. [PMID: 35391559 DOI: 10.1007/s00268-022-06540-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Matthew Z Wilson
- Department of Surgery, Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, USA.
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10
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Crijns TJ, Fatehi A, Coopwood B, Ring D, Tonn M. Asymptomatic contralateral inguinal and ventral hernias among people with a workers' compensation claim for hernia. J Visc Surg 2021; 159:458-462. [PMID: 34776360 DOI: 10.1016/j.jviscsurg.2021.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
STUDY AIM There is a gap in evidence that demonstrates an increased risk of hernia formation in laborers. A notable incidence of a second asymptomatic hernia among people making a workers' compensation claim for a hernia would suggest that the pathology is not acute and probably not related to work, or the performance of a single strenuous event. PATIENTS AND METHODS We performed a retrospective database study of a consecutive sample of 106 adults who claimed a work-related abdominal hernia between September 2016 and December 2018 and had a Computed Tomography (CT) scan as part of a diagnostic workup. Hernias were classified as incidental if patients had a contralateral inguinal hernia with unilateral groin symptoms, or if patients had a ventral hernia with only groin symptoms or vice versa. RESULTS Thirty-three percent of patients had an incidental hernia. No patient factors were associated with having an incidental hernia. Higher BMI and having a concurrent incidental hernia were associated with lower odds of surgical treatment under the injury claim. CONCLUSION Abdominal symptoms after a work event might lead to a diagnosis of hernia, and there is a notable likelihood that the hernia is incidental and unrelated to work. New symptoms at or near the site of an abdominal hernia may or may not be from the hernia, and very often are more consistent with an abdominal muscle strain. The clinical or imaging finding of an abdominal wall defect or the presence of a hernia may be incidental, unrelated to the physical activity.
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Affiliation(s)
- T J Crijns
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA.
| | - A Fatehi
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - B Coopwood
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - D Ring
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - M Tonn
- Occupational Medicine & Pain Management, OccMD Group, Texas Health Dallas, Dallas, TX, USA
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Olavarria OA, Bernardi K, Holihan JL, Lyons NB, Shah P, Ko TC, Kao LS, Liang MK. Prevalence and Impact on Quality of Life of Occult Hernias among Patients Undergoing Computed Tomography. J Surg Res 2020; 253:121-126. [PMID: 32353637 DOI: 10.1016/j.jss.2020.03.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/27/2020] [Accepted: 03/09/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND With the widespread use of advanced imaging there is a need to quantify the prevalence and impact of hernias. We aimed to determine the prevalence of abdominal wall hernias among patients undergoing computed tomography (CT) scans and their impact on abdominal wall quality of life (AW-QOL). METHODS Patients undergoing elective CT abdomen/pelvis scans were enrolled. Standardized physical examinations were performed by surgeons blinded to the CT scan results. AW-QOL was measured through the modified Activities Assessment Scale. On this scale, 1 is poor AW-QOL, 100 is perfect, and a change of 7 is the minimum clinically important difference. Three surgeons reviewed the CT scans for the presence of ventral or groin hernias. The number of patients and the median AW-QOL scores were determined for three groups: no hernia, hernias only seen on imaging (occult hernias), and clinically apparent hernias. RESULTS A total of 246 patients were enrolled. Physical examination detected 62 (25.2%) patients with a hernia while CT scan revealed 107 (43.5%) with occult hernias. The median (interquartile range) AW-QOL of patients per group was no hernia = 84 (46), occult hernia = 77 (57), and clinically apparent hernia = 62 (55). CONCLUSIONS One-fourth of individuals undergoing CT abdomen/pelvis scans have a clinical hernia, whereas nearly half have an occult hernia. Compared with individuals with no hernias, patients with clinically apparent or occult hernias have a lower AW-QOL (by 22 and seven points, respectively). Further studies are needed to determine natural history of AW-QOL and best treatment strategies for patients with occult hernias.
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Affiliation(s)
- Oscar A Olavarria
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center Houston, Houston, Texas; Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas.
| | - Karla Bernardi
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center Houston, Houston, Texas; Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas
| | - Julie L Holihan
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center Houston, Houston, Texas; Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas
| | - Nicole B Lyons
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center Houston, Houston, Texas
| | - Puja Shah
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center Houston, Houston, Texas
| | - Tien C Ko
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center Houston, Houston, Texas
| | - Lillian S Kao
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center Houston, Houston, Texas; Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas
| | - Mike K Liang
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center Houston, Houston, Texas; Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas
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12
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Padilla Herrera CJ, Vega Peña NV, José Barrios AJ, Juan Pablo Ruiz JPR, Lora A. Análisis multicéntrico del reparo de la hernia ventral en instituciones de IV nivel, 2015-2019. REVISTA COLOMBIANA DE CIRUGÍA 2020. [DOI: 10.30944/20117582.587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Introducción. La cirugía de hernia ventral implica una situación de complejidad, dadas las múltiples variables que se deben controlar para estimar los posibles factores determinantes del éxito quirúrgico y la aparición de complicaciones. Según la literatura científica mundial, la incidencia de hernia ventral se estima entre el 10 y el 15 %, y la tasa promedio de complicaciones de esta cirugía varía entre el 10 y el 37 %.
El objetivo del presente estudio fue describir la experiencia y los resultados de la cirugía de hernia ventral en dos instituciones de IV nivel, en el periodo de enero de 2015 a marzo de 2019.
Métodos. Se trata de un estudio observacional, descriptivo y de cohorte histórica, de pacientes mayores de edad sometidos a corrección de hernia ventral en la Clínica Colsanitas en los últimos cinco años. Los datos se tomaron del registro estadístico de las instituciones en mención.
Resultados. Se incluyeron 612 pacientes en un periodo de cinco años, la mayoría de los cuales era de sexo femenino, con sobrepeso, y predominantemente, con defectos combinados mediales; la tasa general de complicaciones fue del 20 % y, el porcentaje de infección del sitio operatorio, de 9 %; para el desarrollo de esta infección, la técnica de separación de componentes se encontró como un factor de riesgo (p=0,01; RR=2,9; IC 95% 1,32-6,5). En este estudio, no se analizó la recidiva como factor de los diferentes resultados.
Conclusiones. Existen pocos datos en la literatura nacional sobre los resultados de este tipo de procedimiento quirúrgico. Es por ello que se procuró brindar a la comunidad científica los resultados de morbimortalidad de esta muestra de pacientes intervenidos por hernia ventral en los últimos cinco años.
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