Journal of Mahatma Gandhi University of Medical Sciences and Technology

Register      Login

VOLUME 3 , ISSUE 3 ( September-December, 2018 ) > List of Articles


Study the Sensitivity and Positive Predictive Value of Clinical Finding, Ultrasonography, and Computed Tomography Finding to Detect the Defect Size and Number of Incisional/Ventral Hernia

Shefali Goyal, Brijesh K Sharma, Mahesh C Misra

Keywords : Correlation, Hernia defect, Measurements, Mesh, Ventral

Citation Information : Goyal S, Sharma BK, Misra MC. Study the Sensitivity and Positive Predictive Value of Clinical Finding, Ultrasonography, and Computed Tomography Finding to Detect the Defect Size and Number of Incisional/Ventral Hernia. J Mahatma Gandhi Univ Med Sci Tech 2018; 3 (3):88-92.

DOI: 10.5005/jp-journals-10057-0090

License: CC BY-NC 4.0

Published Online: 27-06-2019

Copyright Statement:  Copyright © 2018; The Author(s).


Despite the importance of defect size, there are no standardized recommendations on how to measure ventral hernias. Our aims were to determine1 if any significant differences existed between various methods of measuring ventral hernias and2 the effect of these methods of measurement on selection of mesh size. Materials and methods: A prospective study of all patients enrolled in a randomized trial assessing ventral hernia repair at our institution from January 2018 to June 2019 was eligible for inclusion. Abdominal wall hernia defect size will be obtained using the following methods: clinical examination, ultrasonography (USG), and computed tomography (CT) finding. Clinically, measurement will be determined by feeling the edges of muscle and measuring the defect using the measuring tape or thread. Computed tomography abdomen/USG abdomen was done to every patient to confirm the size of defect and its contents of hernia and other associated hernia for estimating the size of the prosthesis to be used. Then, defect size and number of incisional/ventral hernia will be measured intraoperatively using the measuring tape or thread, and this measurement will be compared with the earlier three findings of clinical examination, USG, and CT findings. Results: Thirty patients met inclusion criteria for assessment. Defect size measured by clinical examination in comparison with intraoperative finding of defect size is found out to be statistically significant with a mean value (5.10) more than that of the intraoperative finding (4.85), and p value is <0.05, i.e., 0.012, and defect size measured by USG in comparison with intraoperative finding of defect size is also found out to be statistically significant with a mean value (3.87) less than that of the intraoperative finding (4.85), and p value is <0.05, i.e., 0.036. But the size of defect of hernia measured by CT scan is almost same as that of hernia measured during intraoperative finding with a mean value of 4.60 and 4.85, respectively. Conclusion: Among the three methods of measuring ventral hernia defect, CT scan is most sensitive in detecting the number of hernia and measuring the size of defect followed by clinical examination. Although our study has some limitations due to which we can make no recommendations regarding the ideal measurement method right now. Further studies are needed to determine which method results in optimally sized abdominal wall prostheses and superior ventral hernia repair.

PDF Share
  1. Cherela DV, Lew DF, Escamilla RJ, et al. Differences of alternative methods of measuring abdominal wall hernia defect size. Surg Endosc 2018;32(3):1228–1233.
  2. Baucom RB, Beck WC, Phillips SE, et al. Comparative evaluation of dynamic abdominal sonography for hernia and CT for characterization of Incisional hernia. JAMA Surg 2014;149(6):591–596. DOI: 10.1001/jamasurg.2014.36.
  3. Den Hartog D, Dur AH, Kamphuis AGA, et al. Comparison of USG with CT in the diagnosis of incisional hernia. Hernia 2009;13(1):45–48. DOI: 10.1007/s10029-008-0420-y.
  4. Kurmann A, Visth E, Candinas D, et al. Long-term follow-up of open and laparoscopic repair of large Incisional hernias. World J Surg 2011;35(2):297–301. DOI: 10.1007/s00268-010-0874-9.
  5. Le D, Deveney CW, Reaven NL, et al. Mesh choice in ventral hernia repair: so many choices, so little time. Am J Surg 2013;205(5):602–607. DOI: 10.1016/j.amjsurg.2013.01.026.
  6. Kapischke M, Schulz T, Schipper T, et al. Open versus laparoscopic Incisional hernia repair: something different from a meta-analysis. Surg Endosc 2008;22(10):2251–2260. DOI: 10.1007/s00464-008-9773-7.
  7. Primary fascial closure with laparoscopic ventral hernia repair: a randomized controlled trial. https://clinical Accessed 11 Dec 2016.
  8. McHugh ML. Interrater reliability: the kappa statistic. Biochem Med (Zagreb) 2012;22(3):276–282. DOI: 10.11613/BM.2012.031.
  9. Muysoms FE, Miserez M, Berrevoet F, et al. Classification of primary and Incisional abdominal wall hernias. Hernia 2009;13(4):407–414. DOI: 10.1007/s10029-009-0518-x.
  10. LeBlanc K. Proper mesh overlap is a key determinant in hernia recurrence following laparoscopic ventral and Incisional hernia repair. Hernia 2016;20(1):85–99. DOI: 10.1007/s10029-015-1399-9.
  11. Carter SA, Hicks SC, Brahmbhatt R, et al. Recurrence and pseudorecurrence after laparoscopic ventral hernia repair: predictors and patient-focused outcomes. Am Surg 2014;80(2):138–148.
  12. Guidelines for laparoscopic ventral hernia repair. SAGES [cited 18 Mar 2017]. Available from: Accessed 18 Mar 2017.
  13. Moreno-Egea A, Carrasco L, Girela E, et al. Open vs laparoscopic repair of spigelian hernia: a prospective randomized trial. Arch Surg 2002;137(11):1266–1268. DOI: 10.1001/archsurg.137.11.1266.
  14. Awaiz A, Rahman F, Hossain MB, et al. Meta-analysis and systematic review of laparoscopic versus open mesh repair for elective Incisional hernia. Hernia 2015;19(3):449–463. DOI: 10.1007/s10029-015- 1351-z.
  15. Bernal E, Casado S, Grasa OG, et al. Computer vision distance measurement from endoscopic sequences: prospective evaluation in laparoscopic ventral hernia repair. Surg Endosc 2014;28(12): 3506–3512. DOI: 10.1007/s00464-014-3632-5.
  16. Mudge M, Hughes LE. Incisional hernia: a 10 year prospective study of incidence and attitudes. Br J Surg 1985;72(1):70–71. DOI: 10.1002/bjs.1800720127.
  17. Bosanquet DC, Ansell J, Abdelrahman T, et al. Systematic review and meta-regression of factors affecting midline Incisional hernia rates: analysis of 14 618 patients. PLoS ONE 2015;10(9):e0138745. DOI: 10.1371/journal.pone.0138745.
  18. Deerenberg EB, Harlaar JJ, Steyerberg EW, et al. Small bites versus large bites for closure of abdominal midline incisions (STITCH): a double-blind, multicentre, randomised controlled trial. Lancet 2015;86(10000):1254–1260. DOI: 10.1016/S0140-6736(15)60459-7.
  19. Baucom RB, Beck WC, Holzman MD, et al. Prospective evaluation of surgeon physical examination for detection of Incisional hernias. J Am Coll Surg 2014;218(3):363–366. DOI: 10.1016/j.jamcollsurg.2013. 12.007.
  20. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009;6(7):e1000097.
  21. Interval C (2010) Oxford Centre for Evidence-based Medicine Levels of Evidence (May 2001).
  22. Muysoms FE, Antoniou SA, Bury K, et al. European hernia society guidelines on the closure of abdominal wall incisions. Hernia 2015;19(1):1–24. DOI: 10.1007/s10029-014-1342-5.
  23. Bloemen A, Van Dooren P, Huizinga BF, et al. Comparison of ultrasonography and physical examination in the diagnosis of Incisional hernia in a prospective study. Hernia 2012;16(1):53–57. DOI: 10.1007/s10029-011-0865-2.
  24. Goodenough CJ, Ko TC, Kao LS, et al. Development and validation of a risk stratification score for ventral Incisional hernia after abdominal surgery: hernia xpectation rates in intra-abdominal surgery (the HERNIA project). J Am Coll Surg 2015;220(4):405–413. DOI: 10.1016./j.jamc olls urg.2014.12.027.
  25. de la Peña CG, Romero JV, García JAD. The value of CT diagnosis of hernia recurrence after prosthetic repair of ventral Incisional hernias. Eur Radiol 2001;11(7):1161–1164. DOI: 10.1007/s003300000743.
  26. Beck WC, Holzman MD, Sharp KW, et al. Comparative effectiveness of dynamic abdominal Sonography for hernia vs computed tomography in the diagnosis of Incisional hernia. J Am Coll Surg 2013;216(3): 447–453. DOI: 10.1016/j.jamc olls urg.2012.11.012.
  27. Korenkov M, Paul A, Sauerland S, et al. Classification and surgical treatment of incisional hernia. results of an experts’ meeting. Langenbecks Arch Surg 2001;386(1):65–73. DOI: 10.1007/s004230000182.
  28. Caro-Tarrago A, Casas CO, Salido AJ, et al. Prevention of incisional hernia in midline laparotomy with an onlay mesh: a randomized clinical trial. World J Surg 2014;38(9):2223–2230. DOI: 10.1007/s00268-014-2510-6.
  29. Claes K, Beckers R, Heindryckx E, et al. Retrospective observational study on the incidence of Incisional hernias after colorectal carcinoma resection with follow-up CT scan. Hernia 2014;18(6):787–802. DOI: 10.1007/s10029-014-1214-z.
  30. Bloemen A, Van Dooren P, Huizinga BF, et al. Randomized clinical trial comparing polypropylene or polydioxanone for midline abdominal wall closure. Br J Surg 2011;98(5):633–639. DOI: 10.1002/bjs.7398.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.