Division of Minimal Access and Bariatric Surgery, Department of Surgery, Prisma Health-Upstate, Greenville, SC, USA.
Division of Minimal Access and Bariatric Surgery, Department of Surgery, University of South Carolina School of Medicine Greenville, Prisma Health-Upstate, 701 Grove Rd. ST3, Greenville, SC, 29605, USA.
Hernia. 2021 Apr;25(2):471-477. doi: 10.1007/s10029-020-02181-y. Epub 2020 Apr 10.
Currently, the need for additional myofascial release (AMR) in addition to retromuscular dissection during open Rives-Stoppa hernia repair is determined intraoperatively based on the discretion of the surgeon. We developed a novel method to objectively predict the need for AMR preoperatively using computed tomography (CT)-measured rectus width to hernia width ratio (RDR).
A retrospective chart review of all patients who underwent open retro-muscular mesh repair of midline ventral hernia between August 1, 2007 and February 1, 2018, who had a preoperative CT scan within 1 year prior to their operation. The primary endpoint was the ability of the defect ratio to predict the need for AMR in pursuit of fascial closure. The secondary endpoint was the ability of Component Separation Index (CSI) to predict the need for AMR to obtain fascial closure.
Of 342 patients, 208 repaired with rectus abdominis release alone (RM group), while 134 required AMR (RM + group). An RDR of > 1.34 on area under the curve analysis predicted the need for AMR with 77.6% accuracy. There was a linear decrease in the need for AMR with increasing RDR: RDR < 1 required AMR in 78.8% of cases, RDR 1.1-1.49 in 52%, RDR 1.5-1.99 in 32.1%, and RDR > 2 in just 10.8%. Similarly, CSI > 0.146 predicted the need for AMR with 76.3% accuracy on area under the curve analysis.
The RDR is a practical and reliable tool to predict the ability to close the defect during open Rives-Stoppa ventral hernia repair without AMR. An RDR of > 2 portends fascial closure with rectus abdominis myofascial release alone in 90% of cases.
目前，开放式 Rives-Stoppa 疝修补术中是否需要额外的筋膜松解（AMR），是根据外科医生的判断在术中决定的。我们开发了一种新的方法，使用 CT 测量的腹直肌宽度与疝宽度比（RDR）来预测术前 AMR 的需求。
回顾性分析 2007 年 8 月 1 日至 2018 年 2 月 1 日期间接受开放式后肌网片修补中线腹疝的所有患者的病历，这些患者在手术前 1 年内都进行了术前 CT 扫描。主要终点是缺损比预测为获得筋膜闭合而进行 AMR 的能力。次要终点是组件分离指数（CSI）预测获得筋膜闭合所需 AMR 的能力。
在 342 例患者中，208 例单独行腹直肌松解（RM 组），134 例需要 AMR（RM+组）。ROC 分析中 RDR>1.34 预测 AMR 的准确率为 77.6%。随着 RDR 的增加，对 AMR 的需求呈线性下降：RDR<1 时需要 AMR 的比例为 78.8%，RDR 1.1-1.49 为 52%，RDR 1.5-1.99 为 32.1%，RDR>2 仅为 10.8%。同样，CSI>0.146 在 ROC 分析中预测 AMR 的准确率为 76.3%。
RDR 是一种实用可靠的工具，可以预测在不进行 AMR 的情况下，开放式 Rives-Stoppa 腹疝修补术中关闭缺损的能力。RDR>2 时，90%的病例可以单独用腹直肌筋膜松解来闭合筋膜。
