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Ghafoor S, Hoppe AT, Lange M, Tognella A, Bueter M, Lehmann K, Alkadhi H, Stocker D. Computed tomography for evaluation of abdominal wall hernias-what is the value of the Valsalva maneuver? Hernia 2024:10.1007/s10029-024-03036-6. [PMID: 38874659 DOI: 10.1007/s10029-024-03036-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 03/29/2024] [Indexed: 06/15/2024]
Abstract
PURPOSE To investigate the differences in the visibility and size of abdominal wall hernias in computed tomography (CT) with and without Valsalva maneuver. METHODS This single-center retrospective study included consecutive patients who underwent abdominal CTs with Valsalva maneuver between January 2018 and January 2022. Inclusion criteria was availability of an additional non-Valsalva CT within 6 months. A combined reference standard including clinical and surgical findings was used. Two independent, blinded radiologists measured the hernia sac size and rated hernia visibility on CTs with and without Valsalva. Differences were tested with a Wilcoxon signed rank test and McNemar's test. RESULTS The final population included 95 patients (16 women; mean age 46 ± 11.6 years) with 205 hernias. Median hernia sac size on Valsalva CT was 31 mm compared with 24 mm on non-Valsalva CT (p < 0.001). In 73 and 82% of cases, the hernias were better visible on CT with Valsalva as compared to that without. 14 and 17% of hernias were only visible on the Valsalva CT. Hernia visibility on non-Valsalva CT varied according to subtype, with only 0 and 3% of umbilical hernias not being visible compared with 43% of femoral hernias. CONCLUSIONS Abdominal wall hernias are larger and better visible on Valsalva CT compared with non-Valsalva CT in a significant proportion of patients and some hernias are only visible on the Valsalva CT. Therefore, this method should be preferred for the evaluation of abdominal wall hernias.
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Affiliation(s)
- S Ghafoor
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - A T Hoppe
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - M Lange
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - A Tognella
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - M Bueter
- Department of Visceral and Transplantation Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - K Lehmann
- Department of Visceral and Transplantation Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - H Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - D Stocker
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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2
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Gandhi JA, Shinde PH, Banker AM, Takalkar Y. Computed tomography for ventral hernia: Need for a standardised reporting format. J Minim Access Surg 2023; 19:175-177. [PMID: 35915534 PMCID: PMC10034791 DOI: 10.4103/jmas.jmas_34_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- Jignesh A Gandhi
- Department of General Surgery, Seth GSMC and KEM Hospital, Mumbai, Maharashtra, India
| | - Pravin H Shinde
- Department of General Surgery, Seth GSMC and KEM Hospital, Mumbai, Maharashtra, India
| | - Amay M Banker
- Department of General Surgery, Seth GSMC and KEM Hospital, Mumbai, Maharashtra, India
| | - Yogesh Takalkar
- Department of General Surgery, Seth GSMC and KEM Hospital, Mumbai, Maharashtra, India
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3
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Claus CMP, Cavalieiri M, Malcher F, Trippia C, Eiras-Araujo AL, Pauli E, Cavazzola LT. DECOMP Report: Answers surgeons expect from an abdominal wall imaging exam. Rev Col Bras Cir 2022; 49:e20223172. [PMID: 35588534 PMCID: PMC10578831 DOI: 10.1590/0100-6991e-20223172en] [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: 08/25/2021] [Accepted: 11/03/2021] [Indexed: 11/22/2022] Open
Abstract
Abdominal wall (AW) hernias are a common problem faced by general surgeons. With an essentially clinical diagnosis, abdominal hernias have been considered a simple problem to be repaired. However, long-term follow-up of patients has shown disappointing results, both in terms of complications and recurrence. In this context, preoperative planning with control of comorbidities and full knowledge of the hernia and its anatomical relationships with the AW has gained increasing attention. Computed tomography (CT) appears to be the best option to determine the precise size and location of abdominal hernias, presence of rectus diastase and/or associated muscle atrophy, as well as the proportion of the hernia in relation to the AW itself. This information might help the surgeon to choose the best surgical technique (open vs MIS), positioning and fixation of the meshes, and eventual need for application of botulinum toxin, preoperative pneumoperitoneum or component separation techniques. Despite the relevance of the findings, they are rarely described in CT scans as radiologists are not used to report findings of the AW as well as to know what information is really needed. For these reasons, we gathered a group of surgeons and radiologists to establish which information about the AW is important in a CT. Finally, a structured report is proposed to facilitate the description of the findings and their interpretation.
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Affiliation(s)
| | - Marcio Cavalieiri
- - Hospital Municipal Lourenço Jorge, Clínica Cirúrgica - Rio de Janeiro - RJ - Brasil
| | - Flávio Malcher
- - New York University Grossman School of Medicine, Abdominal Core Health - New York - NY - Estados Unidos
| | - Carlos Trippia
- - Hospital Nossa Senhora das Graças, Radiologia - Curitiba - PR - Brasil
| | - Antonio Luis Eiras-Araujo
- - Universidade Federal do Rio de Janeiro e Instituto D'Or de Ensino e Pesquisa, Radiologia - Rio de Janeiro - RJ - Brasil
| | - Eric Pauli
- - Penn State Hershey Medical Center, Minimally Invasive and Bariatric Surgery - Hershey - PA - Estados Unidos
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CLAUS CHRISTIANOMARLOPAGGI, CAVALIEIRI MARCIO, MALCHER FLÁVIO, TRIPPIA CARLOS, EIRAS-ARAUJO ANTONIOLUIS, PAULI ERIC, CAVAZZOLA LEANDROTOTTI. Relatório DECOMP: Respostas que os cirurgiões esperam de um exame de imagem da parede abdominal. Rev Col Bras Cir 2022. [DOI: 10.1590/0100-6991e-20223172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Hérnias da parede abdominal são um problema bastante comum enfrentado pelo cirurgiões gerais. De diagnóstico essencialmente clínico, as hérnias abdominais durante muito tempo têm sido consideradas um problema de simples reparo. Entretanto, o acompanhamento de longo prazo dos pacientes têm demonstrado resultados desapontadores, tanto em termos de complicações quanto risco de recidiva da hérnia. Neste contexto, o planejamento pré-operatório com controle de comorbidades e pleno conhecimento da hérnia e suas relações anatômicas com a parede abdominal têm ganho cada vez mais atenção. A tomografia de abdome parece ser a melhor opção para determinar o tamanho e localização precisos das hérnias abdominais, presença de diastase de músculo reto e/ou atrofia da parede associada, assim como proporção da hérnia em relação a parede abdominal. Essas informações podem auxiliar o cirurgião na escolha da melhor técnica cirúrgica (aberta vs. MIS), posicionamento e fixação das telas, e eventual necessidade de aplicação de toxina botulínica, pneumoperitônio pré-operatório ou técnicas de separação de componentes. Apesar da relevância dos achados, eles são raramente descritos em exames de tomografia uma vez que os radiologistas não estão acostumados a olhar para a parede abdominal assim como não sabem quais as informações são realmente necessárias. Por estes motivos, nós reunimos um grupo de cirurgiões e radiologistas visando estabelecer quais são as informações da parede abdominal mais importantes em um exame de tomografia assim como propor um laudo estruturado para facilitar a descrição dos achados e sua interpretação.
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Affiliation(s)
| | | | | | | | | | - ERIC PAULI
- Penn State Hershey Medical Center, Estados Unidos
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5
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Aimanan K, Mohd Nor MR, Ling W, Che Ghazali K, Ahmad Hamidi AJ, Hayati F, Zakaria Z, Sagap I. Role of imaging in managing lateral trocar site incisional hernia after abdominoperineal resection. Radiol Case Rep 2021; 16:3457-3460. [PMID: 34527123 PMCID: PMC8429612 DOI: 10.1016/j.radcr.2021.08.031] [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: 08/04/2021] [Accepted: 08/11/2021] [Indexed: 11/30/2022] Open
Abstract
Trocar site incisional hernia (TSIH) is an unpleasant complication of laparoscopic surgery. A 70-year-old male with low rectal carcinoma underwent a laparoscopic abdominoperineal resection after completion of neoadjuvant radiotherapy. The postoperative recovery was smooth; however, he developed abdominal distension and pain over the previous drain site after removal on day 3. In view of diagnostic ambiguity, an imaging tool was requested as an adjunct to further management. Computed tomography of the abdomen showed small bowel obstruction secondary to herniated ileal loops passing through the right iliac fossa anterior abdominal wall defect at the previous drainage site. An exploration was made and the rectus defect was closed using a non-absorbable suture.
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Affiliation(s)
- Karthigesu Aimanan
- Department of Surgery, Miri Hospital, Ministry of Health Malaysia, Miri, Sarawak, Malaysia
| | | | - Wong Ling
- Department of Surgery, Miri Hospital, Ministry of Health Malaysia, Miri, Sarawak, Malaysia
| | | | | | - Firdaus Hayati
- Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
| | - Zaidi Zakaria
- Department of Surgery, School of Medical Sciences, Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Ismail Sagap
- Colorectal Unit, Department of Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia
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6
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Cocco G, Ricci V, Boccatonda A, Stellin L, De Filippis G, Soresi M, Schiavone C. Sonographic demonstration of a spontaneous rectus sheath hematoma following a sneeze: a case report and review of the literature. J Ultrasound 2021; 24:125-130. [PMID: 32621122 PMCID: PMC8137746 DOI: 10.1007/s40477-020-00493-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/09/2020] [Indexed: 12/27/2022] Open
Abstract
Spontaneous rectus sheath hematoma (SRSH) is an uncommon cause of acute abdominal pain characterized by bleeding within the rectus sheath; it is a benign condition and, in most cases, it is treated conservatively. Bleeding of the abdominal wall is an unusual condition that is quite challenging to identify promptly and can be easily overlooked during a routine physical examination. In daily practice, anticoagulant therapy is one of the main risk factors for hemorrhagic events. In this respect, we report a rare case of spontaneous hematoma of the abdominal wall (diagnosed and monitored through an ultrasound examination) that arose after sneezing in a patient receiving anticoagulant treatment.
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Affiliation(s)
- G Cocco
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Science of Aging, "G. d'Annunzio" University, Chieti, Italy.
| | - V Ricci
- Department of Biomedical and Neuromotor Science, Physical and Rehabilitation Medicine Unit, IRCCS Rizzoli Orthopedic Institute, Bologna, Italy
| | - A Boccatonda
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Science of Aging, "G. d'Annunzio" University, Chieti, Italy
| | - L Stellin
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Science of Aging, "G. d'Annunzio" University, Chieti, Italy
| | - G De Filippis
- Radiology Department, "M.G. Vannini Hospital", Rome, Italy
| | - M Soresi
- Internal Medicine and Medical Specialties (PROMISE), Department of Health Promotion Sciences, Maternal and Infant Care, University of Palermo, Palermo, Italy
| | - C Schiavone
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Science of Aging, "G. d'Annunzio" University, Chieti, Italy
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7
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Gavlin A, Kierans AS, Chen J, Song C, Guniganti P, Mazzariol FS. Imaging and Treatment of Complications of Abdominal and Pelvic Mesh Repair. Radiographics 2021; 40:432-453. [PMID: 32125951 DOI: 10.1148/rg.2020190106] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Surgical mesh is used most frequently for tension-free repair of abdominal wall hernias in adults, because the rate of hernia recurrence is lower with mesh than with primary soft-tissue repair. Since the introduction of polypropylene mesh in the middle of the 20th century, many mesh materials and configurations for specific surgical procedures have been developed. In addition to abdominal wall hernia repair, mesh may be used for repair of diaphragmatic hernias, urinary incontinence in women (female slings), genitourinary prolapse (vaginal mesh and sacrocolpopexy), rectal prolapse (rectopexy), and postprostatectomy male urinary incontinence (male slings). General mesh repair complications include chronic pain; fluid collections such as seromas, hematomas, and abscesses; adhesions that may lead to intestinal blockage; erosion into solid or hollow viscera including enterocutaneous fistulizing disease; and mesh failure characterized by mesh shrinkage, detachment, and migration with repair malfunction. Several mesh complications are often diagnosed with imaging, primarily with CT and less frequently with MRI and US, despite variable mesh visibility at imaging. This article reviews the common surgical mesh applications in the abdomen and pelvis, discusses imaging of mesh repair complications, and provides complication treatment highlights.©RSNA, 2020.
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Affiliation(s)
- Alexander Gavlin
- From the Department of Radiology, Division of Abdominal Imaging, New York Presbyterian Hospital, Weill Cornell Medical Center, 525 E 68th St, Box 141, New York, NY 10065
| | - Andrea S Kierans
- From the Department of Radiology, Division of Abdominal Imaging, New York Presbyterian Hospital, Weill Cornell Medical Center, 525 E 68th St, Box 141, New York, NY 10065
| | - Johnson Chen
- From the Department of Radiology, Division of Abdominal Imaging, New York Presbyterian Hospital, Weill Cornell Medical Center, 525 E 68th St, Box 141, New York, NY 10065
| | - Christopher Song
- From the Department of Radiology, Division of Abdominal Imaging, New York Presbyterian Hospital, Weill Cornell Medical Center, 525 E 68th St, Box 141, New York, NY 10065
| | - Preethi Guniganti
- From the Department of Radiology, Division of Abdominal Imaging, New York Presbyterian Hospital, Weill Cornell Medical Center, 525 E 68th St, Box 141, New York, NY 10065
| | - Fernanda S Mazzariol
- From the Department of Radiology, Division of Abdominal Imaging, New York Presbyterian Hospital, Weill Cornell Medical Center, 525 E 68th St, Box 141, New York, NY 10065
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8
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Köckerling F, Hoffmann H, Adolf D, Reinpold W, Kirchhoff P, Mayer F, Weyhe D, Lammers B, Emmanuel K. Potential influencing factors on the outcome in incisional hernia repair: a registry-based multivariable analysis of 22,895 patients. Hernia 2021; 25:33-49. [PMID: 32277370 PMCID: PMC7867532 DOI: 10.1007/s10029-020-02184-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 03/30/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Due to the paucity of randomized controlled trials, meta-analyses of incisional hernia repair can hardly give any insights into the influence factors on the various outcome criteria. Therefore, a multivariable analysis of data from the Herniamed Registry was undertaken with the aim to define potential influencing factors for the outcome. METHODS Multivariable analysis of the data available for 22,895 patients with primary elective incisional hernia repair was performed to assess the confirmatory predefined potential influence factors and their association with the perioperative and 1-year follow-up outcomes. A model validation procedure was implemented using a bootstrap algorithm in order to account for the robustness of results. RESULTS Higher European Hernia Society (EHS) width classification, open procedure, female gender, and preoperative pain have a highly significant association with an unfavorable outcome in incisional hernia repair. Larger defect width and open operation have a highly significantly unfavorable relation to the postoperative surgical complications, general complications, and the complication-related reoperations, while female gender and preoperative pain have a highly significantly unfavorable association with the rates of pain at rest, pain on exertion, and chronic pain requiring treatment at 1-year follow-up. The recurrence rate is significantly unfavorably influenced by higher EHS width classification, higher BMI, and lateral EHS classification. CONCLUSION Higher EHS width classification, open procedure, female gender, higher BMI, and lateral EHS classification, as well as preoperative pain are the most important unfavorable influencing factors associated with a worse outcome in incisional hernia repair.
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Affiliation(s)
- F Köckerling
- Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany.
| | - H Hoffmann
- Two Surgeons-Center for Hernia Surgery and Proctology, St. Johanns-Vorstadt 44, 4056, Basel, Switzerland
| | - D Adolf
- StatConsult GmbH, Halberstädter Strasse 40 a, 39112, Magdeburg, Germany
| | - W Reinpold
- Department of Surgery, Wilhelmsburger Hospital Gross Sand, Academic Teaching Hospital of University Hamburg, Gross Sand 3, 21107, Hamburg, Germany
| | - P Kirchhoff
- Two Surgeons-Center for Hernia Surgery and Proctology, St. Johanns-Vorstadt 44, 4056, Basel, Switzerland
| | - F Mayer
- Department of Surgery, Paracelsus Medical University Salzburg, Müllner Hauptstrasse 48, 5020, Salzburg, Austria
| | - D Weyhe
- Department of General and Visceral Surgery, Pius Hospital, University Hospital of Visceral Surgery, Georgstrasse 12, 26121, Oldenburg, Germany
| | - B Lammers
- Department of Surgery I-Section Coloproctology and Hernia Surgery, Lukas Hospital, Preussenstrasse 84, 41464, Neuss, Germany
| | - K Emmanuel
- Department of Surgery, Paracelsus Medical University Salzburg, Müllner Hauptstrasse 48, 5020, Salzburg, Austria
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Kushner B, Starnes C, Sehnert M, Holden S, Blatnik J. Identifying critical computed tomography (CT) imaging findings for the preoperative planning of ventral hernia repairs. Hernia 2020; 25:963-969. [PMID: 33025298 DOI: 10.1007/s10029-020-02314-3] [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: 07/16/2020] [Accepted: 09/22/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Computed Tomography (CT) reports vary in qualitative detail and may not capture the information required for the preoperative planning of ventral hernia repairs. The goals of this study were to first survey general and hernia surgeons to establish key hernia imaging characteristics that should be included on CT reports and secondly, to retrospectively review preoperative CTs to determine the percentage that these same imaging characteristics are being reported. METHODS General and hernia surgeons were surveyed and asked to rank important hernia imaging factors as determined by two academic hernia surgeons on a Likert scoring scale. Additionally, preoperative abdominal/pelvic CT reports of patients who underwent a ventral hernia repair at a single academic institution were retrospectively reviewed for the presence of these imaging factors. RESULTS Fifty-one general and hernia surgeons responded to the survey. The most important imaging findings as determined by survey respondents were size of the hernia defect and presence of previous mesh. Additionally, 61% of respondents felt that the imaging report was less important than their own personal CT interpretation. Of the 257 preoperative CT reports reviewed, the number of defects was the most commonly reported factor (100%). The size of the defect and the presence of prior mesh was only included on 38% and 15% of reports, respectively. CONCLUSIONS CT reports vary in their reported imaging findings and often fail to include important preoperative hernia features. Future studies should aim to standardize imaging reports to better utilize CTs for the preoperative planning of abdominal wall reconstructions.
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Affiliation(s)
- Bradley Kushner
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, 63110, USA. .,Department of Minimally Invasive Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8109, St. Louis, MO, 63110, USA.
| | - Carter Starnes
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Maggie Sehnert
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Sara Holden
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Jeffrey Blatnik
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, 63110, USA
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Chatterjee A, Ramanan RV, Mukhopadhyay S. Imaging Postoperative Abdominal Hernias: A Review with a Clinical Perspective. JOURNAL OF GASTROINTESTINAL AND ABDOMINAL RADIOLOGY 2020. [DOI: 10.1055/s-0040-1715772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
AbstractPostoperative internal hernia is a challenging but critical diagnosis in postoperative patients presenting with acute abdomen. Postoperative internal hernias are increasingly being recognized after Roux-en-Y gastric bypass (RYGB) and bariatric surgeries. These internal hernias have a high risk of closed-loop obstruction and bowel ischemia; therefore, prompt recognition is necessary. Computed tomography (CT) is the imaging modality of choice in cases of postoperative acute abdomen. Understanding the types of postoperative internal hernia and their common imaging features on CT is crucial for the abdominal radiologist. Postoperative external hernias are usually a result of defect or weakness of the abdominal wall created because of the surgery. CT helps in the detection, delineation, diagnosis of complications, and surgical planning of an external hernia. In this article, the anatomy, pathophysiology, and CT features of common postoperative hernias are discussed. Afterreading this review, the readers should be able to (1) enumerate the common postoperative internal and external abdominal hernias, (2) explain the pathophysiology and surgical anatomy of Roux-en-Y gastric bypass-related hernia, (3) identify the common imaging features of postoperative hernia, and (4) diagnose the complications of postoperative hernias.
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Affiliation(s)
- Argha Chatterjee
- Department of Radiology and Imaging, Tata Medical Center, Kolkata, West Bengal, India
| | | | - Sumit Mukhopadhyay
- Department of Radiology and Imaging, Tata Medical Center, Kolkata, West Bengal, India
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11
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Draghi F, Cocco G, Richelmi FM, Schiavone C. Abdominal wall sonography: a pictorial review. J Ultrasound 2020; 23:265-278. [PMID: 32125676 DOI: 10.1007/s40477-020-00435-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 02/13/2020] [Indexed: 02/07/2023] Open
Abstract
The anterior abdominal wall, which is composed of three layers (skin and adipose tissues; the myofascial layer; and the deep layer, consisting of the transversalis fascia, preperitoneal fat, and the parietal peritoneum), has many functions: containment, support and protection for the intraperitoneal contents, and involvement in movement and breathing. While hernias are often encountered and well reviewed in the literature, the other abdominal wall pathologies are less commonly described. In this pictorial review, we briefly discuss the normal anatomy of the anterior abdominal wall, describe the normal ultrasonographic anatomy, and present a wide range of pathologic abnormalities beyond hernias. Sonography emerges as the diagnostic imaging of first choice for assessing abdominal wall disorders, thus representing a valuable tool for ensuring appropriate management and limiting functional impairment.
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Affiliation(s)
- Ferdinando Draghi
- Radiology Institute, IRCCS Policlinico San Matteo Foundation, University of Pavia, Viale Camillo Golgi 19, 27100, Pavia, Italy
| | - Giulio Cocco
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Aging Sciences, University of Chieti G d'Annunzio, Via dei Vestini 31, 66100, Chieti, Italy.
| | - Filippo Maria Richelmi
- Radiology Institute, IRCCS Policlinico San Matteo Foundation, University of Pavia, Viale Camillo Golgi 19, 27100, Pavia, Italy
| | - Cosima Schiavone
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Aging Sciences, University of Chieti G d'Annunzio, Via dei Vestini 31, 66100, Chieti, Italy
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12
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Abstract
We present a case-based review of abdominal postoperative complications, organized by organ system affected, including wound/superficial, hepatobiliary, pancreatic, gastrointestinal, genitourinary, and vascular complications. Both general complications and specific considerations for certain types of operations are described, as well as potential pitfalls that can be confused with complications. Representative cases are shown using all relevant imaging modalities, including CT, fluoroscopy, ultrasound, MRI, and nuclear medicine. Management options are also described, highlighting those that require radiologist input or intervention.
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Affiliation(s)
- Ryan B O'Malley
- Department of Radiology, Abdominal Imaging, University of Washington, 1959 Northeast Pacific Street, Box 357115, Seattle, WA 98195, USA.
| | - Jonathan W Revels
- Department of Radiology, Body and Thoracic Imaging, University of New Mexico, Albuquerque, NM, USA
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13
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Köckerling F, Sheen AJ, Berrevoet F, Campanelli G, Cuccurullo D, Fortelny R, Friis-Andersen H, Gillion JF, Gorjanc J, Kopelman D, Lopez-Cano M, Morales-Conde S, Österberg J, Reinpold W, Simmermacher RKJ, Smietanski M, Weyhe D, Simons MP. Accreditation and certification requirements for hernia centers and surgeons: the ACCESS project. Hernia 2019; 23:185-203. [PMID: 30671899 PMCID: PMC6456484 DOI: 10.1007/s10029-018-1873-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 12/11/2018] [Indexed: 12/15/2022]
Abstract
INTRODUCTION There is a need for hernia centers and specialist hernia surgeons because of the increasing complexity of hernia surgery procedures due to new techniques, more difficult cases and a tailored approach with an increasing public awareness demanding optimal treatment results. Therefore, the requirements for accredited/certified hernia centers and specialist hernia surgeons should be formulated by the international and national hernia societies, while taking account of the respective health care systems. METHODS The European Hernia Society (EHS) has appointed a working group composed of 18 hernia experts from all regions of Europe (ACCESS Group-Hernia Accreditation and Certification of Centers and Surgeons-Working Group) to formulate scientifically based requirements for hernia centers and specialist hernia surgeons while taking into consideration different health care systems. A consensus was reached on the key questions by means of a meeting, a telephone conference and the exchange of contributions. The requirements formulated below were deemed implementable by all participating hernia experts in their respective countries. RESULTS The ACCESS Group suggests for an adequately equipped hernia center the following requirements: (a) to be accredited/certified by a national or international hernia society, (b) to perform a higher case volume in all types of hernia surgery compared to an average general surgery department in their country, (c) to be staffed by experienced hernia surgeons who are beyond the learning curve for all types of hernia surgery recommended in the guidelines and are responsible for education and training of hernia surgery in their department, (d) to treat hernia patients according to the current guidelines and scientific recommendations, (e) to document each case prospectively in a registry or quality assurance database (f) to perform follow-up for comparison of their own results with benchmark data for continuous improvement of their treatment results and ensuring contribution to research in hernia treatment. To become a specialist hernia surgeon, the ACCESS Group suggests a general surgeon to master the learning curve of all open and laparo-endoscopic hernia procedures recommended in the guidelines, perform a high caseload and additionally to implement and fulfill the other requirements for a hernia center. CONCLUSION Based on the above requirements formulated by the European Hernia Society for accredited/certified hernia centers and hernia specialist surgeons, the national and international hernia societies can now develop their own programs, while taking account of their specific health care systems.
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Affiliation(s)
- F Köckerling
- Department of Surgery, Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany.
| | - A J Sheen
- Associate Clinical Head of Division (Surgery), Manchester University NHS Foundation Trust, Manchester, UK
| | - F Berrevoet
- General and HPB Surgery and Liver Transplantations, Pancreas and Abdominal Wall Specialist, Universitair Ziekenhuis Gent, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - G Campanelli
- General and Day Surgery Unit, Center of Research and High Specialization for the Pathologies of Abdominal Wall and Surgical Treatment and Repair of Abdominal Hernia, Milano Hernia Center, Instituto Clinico Sant'Ambrogio, University of Insurbria, Milan, Italy
| | - D Cuccurullo
- Chief Week Surgery Departmental Unit, Department of General, Laparoscopic and Robotic Surgery, A.O. Dei Colli Monaldi Hospital Naples, Naples, Italy
| | - R Fortelny
- Department of General, Visceral and Oncological Surgery, Wilhelminenspital, 1160, Vienna, Austria
| | - H Friis-Andersen
- Surgical Department, Horsens Regional Hospital, Horsens, Denmark
| | - J F Gillion
- Unité de Chirurgie Viscérale, Hôpital Privé d'Antony, 1, Rue Velpeau, 92160, Antony, France
| | - J Gorjanc
- Department of Surgery, Krankenhaus der Barmherzigen Brüder, Spitalgasse 26, 9300, St. Veit an der Glan, Austria
| | - D Kopelman
- Department of Surgery Emek Medical Center, Afula and the Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - M Lopez-Cano
- Abdominal Wall Surgery Unit, Department of General Surgery, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - S Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, University Hospital Virgen del Rocío, Av. Manuel Siurot, s/n, 41013, Seville, Spain
| | - J Österberg
- Department of Surgery, Mora Hospital, 79285, Mora, Sweden
| | - W Reinpold
- Wilhelmsburger Krankenhaus Gross-Sand, Gross-Sand 3, 21107, Hamburg, Germany
| | - R K J Simmermacher
- Department of Surgery, University Medical Center Utrecht, Heidelbergglaan 100, Utrecht, The Netherlands
| | - M Smietanski
- Department of General Surgery and Hernia Centre, Hospital in Puck, Medical University of Gdansk, Gdańsk, Poland
| | - D Weyhe
- School of Medicine and Health Sciences, University Hospital for Visceral Surgery, Pius-Hospital Oldenburg, Medical Campus University of Oldenburg, Georgstrasse 12, 26121, Oldenburg, Germany
| | - M P Simons
- Department of Surgery, OLVG Hospital, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands
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