Wang Ping, Guo Zicheng, Jin Hua, Chen Zhun, Li Qingqing, Huang Yonggang
Department of Hernia and Abdominal Wall Surgery, Hangzhou First People's Hospital, Hangzhou, 310006, PR China.
Heliyon. 2024 Dec 6;11(1):e40690. doi: 10.1016/j.heliyon.2024.e40690. eCollection 2025 Jan 15.
Preoperative decision making prior to incisional hernia repair brings benefits but also presents challenges. Defect width (DW) is the key index in hernia staging but does not precisely indicate the requirement for component separation (CS). DW as a percentage of transverse abdominal diameter (TAD) determined by CT imaging was investigated for its capacity to indicate the necessity of CS for successful defect closure under physiological tension.
A total of 116 patients treated for incisional hernia by surgery between April 1st, 2015 and September 30th, 2020 were enrolled and clinical data retrospectively analyzed. All hernias were repaired with defect closure and mesh reinforcement. 82 patients received Rives-Stoppa repair (RS group) and 34 Rives-Stoppa repair with CS (CS group). Preoperative CT images were reviewed to measure maximum DW and TAD at umbilical level and the DW/TAD percentage (DTP) calculated. Accuracies of DW and DTP in predicting necessity of CS were compared through statistical analysis.
Mean RS DW was 59.41 ± 18.70 mm and CS DW 105.76 ± 13.47 mm ( = 0.000). Mean RS DW/TAD percentage was 21.25 ± 6.48 and CS DW/TAD 38.56 ± 6.26 ( < 0.05). Area under the curve (AUC) for receiver operating characteristic (ROC) curves gave values of 0.798 for DW and 0.825 for DTP ( < 0.05).
DTP is a reliable index with greater accuracy than DW for prediction of the necessity of CS in incisional hernia repair.
切口疝修补术前的决策既有益处，也存在挑战。缺损宽度（DW）是疝分期的关键指标，但不能精确表明是否需要进行补片分离术（CS）。本研究通过CT成像测定缺损宽度占腹横径（TAD）的百分比，以探讨其在生理张力下成功闭合缺损时提示是否需要进行补片分离术的能力。
纳入2015年4月1日至2020年9月30日期间接受手术治疗的116例切口疝患者，并对其临床资料进行回顾性分析。所有疝均采用缺损闭合和补片加强修补。82例患者接受里夫斯-斯托帕修补术（RS组），34例接受里夫斯-斯托帕修补术联合补片分离术（CS组）。回顾术前CT图像，测量脐水平的最大缺损宽度和腹横径，并计算缺损宽度/腹横径百分比（DTP）。通过统计分析比较缺损宽度和缺损宽度/腹横径百分比预测补片分离术必要性的准确性。
RS组平均缺损宽度为59.41±18.70mm，CS组为105.76±13.47mm（P = 0.000）。RS组平均缺损宽度/腹横径百分比为21.25±6.48，CS组为38.56±6.26（P<0.05）。受试者工作特征（ROC）曲线的曲线下面积（AUC）显示，缺损宽度的AUC值为0.798，缺损宽度/腹横径百分比的AUC值为0.825（P<0.05）。
缺损宽度/腹横径百分比是预测切口疝修补术中补片分离术必要性的可靠指标，其准确性高于缺损宽度。
