Identifying critical computed tomography (CT) imaging findings for the preoperative planning of ventral hernia repairs
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ORIGINAL ARTICLE
Identifying critical computed tomography (CT) imaging findings for the preoperative planning of ventral hernia repairs Bradley Kushner1,2 · Carter Starnes1 · Maggie Sehnert1 · Sara Holden1 · Jeffrey Blatnik1 Received: 16 July 2020 / Accepted: 22 September 2020 © Springer-Verlag France SAS, part of Springer Nature 2020
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. Keywords Ventral hernias · Abdominal wall reconstructions · Computed tomography · Preoperative planning
Introduction Ventral hernias, a defect through the main strength layer of the abdominal wall fascia, can cause significant discomfort. While ventral hernias are rarely life-threating, the defect is often associated with life-limiting pain and discomfort, and most patients will elect to have their hernia repaired. Historically, physical exam was the most commonly used modality when diagnosing ventral hernias [1]. However, the sensitivity of the physical exam is severely affected by a patient’s * Bradley Kushner [email protected] 1
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
2
history of previous abdominal wall surgery and obesity [2]. Similarly, hernia pseudorecurrence, such as a seroma, previous mesh, or
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