Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Rue Cognac-Jay, 51092, Reims Cedex, France.
Sultan Qaboos University, Muscat, Sultanate of Oman.
Hernia. 2022 Jun;26(3):927-936. doi: 10.1007/s10029-021-02474-w. Epub 2021 Aug 2.
The treatment of giant incisional hernia (IH) with loss of domain (LOD, IHLD) is considerably challenging due to technical difficulties and subsequent post-operative complications. These post-operative risks may be anticipated by calculating the abdominal cavity (AC) volume (ACV) and the IH volume (IHV) on the preoperative CT-scans, using the AC and IH dimensions (Tanaka's method) or using tridimensional volumetry (Sabbagh's method). These techniques are often time-consuming and require specific softwares. The aim of the present study was to develop a simple method to rapidly obtain the LOD-ratio on the preoperative CT-Scan.
The CT-scans (n = 89) of patients with IHLD were retrospectively studied. Several ratios were calculated using different parameters of the AC and the IH, including width, height and depth, the areas (axial and sagittal ellipse, as well as freehand sagittal surface areas) and these were compared with the reference methods of Sabbagh et al. and Tanaka et al. RESULTS: The LOD ratios calculated from the two reference methods gave similar results (ICC = 0.82, p < 0.0001). The new "R-ratios" (Reims-ratios) obtained from the IH and AC surface areas measured using the "freehand ROI" tool on sagittal view or roughly evaluated by an ellipse on axial view showed excellent correlation with both reference ratios (all ICC ≥ 0.71, p < 0.0001).
The LOD ratio may be quickly obtained by drawing two circles on the pre-operative CT scan ("R ratios") and available on the webpage https://romeo.univ-reims.fr/Rratio/ . This will certainly help surgeons to routinely anticipate the post-operative complications before IHLD repair.
由于技术难度以及随后的术后并发症，巨大切口疝（IH）伴缺失区域（LOD，IHLD）的治疗极具挑战性。通过计算术前 CT 扫描的腹腔（AC）体积（ACV）和 IH 体积（IHV），使用 AC 和 IH 尺寸（田中法）或使用三维容积测量法（萨巴格法），可以预测这些术后风险。这些技术通常耗时且需要特定的软件。本研究旨在开发一种快速在术前 CT 扫描中获得 LOD 比的简单方法。
回顾性研究了 IHLD 患者的 CT 扫描（n=89）。使用 AC 和 IH 的不同参数（宽度、高度和深度、面积（轴向和矢状椭圆以及徒手矢状面面积））计算了几个比值，并与 Sabbagh 等人和 Tanaka 等人的参考方法进行了比较。
两种参考方法计算的 LOD 比值结果相似（ICC=0.82，p<0.0001）。通过在矢状视图上使用“徒手 ROI”工具测量 IH 和 AC 表面积获得的新“R 比值”（Reims 比值），或在轴视图上通过大致评估椭圆获得的 R 比值，与两种参考比值均具有良好的相关性（所有 ICC≥0.71，p<0.0001）。
通过在术前 CT 扫描上绘制两个圆圈（“R 比值”），可以快速获得 LOD 比，并且可以在网页 https://romeo.univ-reims.fr/Rratio/ 上获得。这肯定有助于外科医生在修复 IHLD 之前常规预测术后并发症。
