Clinical Report: Diagnostic Approaches for Incisional Hernia After Abdominal Surgery
Overview
Incisional hernia (IH) is a common complication following open abdominal surgery, with prevalence rates ranging from 10 to 32%. This systematic review evaluates the diagnostic accuracy of physical examination, CT-scan, and ultrasound for IH detection, highlighting variability in diagnostic protocols and definitions that influence reported prevalence.
Background
Incisional hernia is the most frequent complication after open abdominal surgery, influenced by factors such as age, obesity, and previous surgeries. Various diagnostic modalities including physical examination, ultrasound, CT-scan, MRI, and per-operative diagnosis are used, but their accuracy and reliability vary. The European Hernia Society recommends imaging techniques like ultrasound or CT-scan for follow-up in research settings, although clinical practice often relies on symptomatic diagnosis. Differences in IH definitions and diagnostic protocols contribute to variability in reported prevalence rates.
Data Highlights
The systematic review included studies assessing diagnostic performance of physical examination, CT-scan, ultrasound, MRI, and surgery for IH detection. Data extracted included prevalence rates, contingency tables, kappa values, and intra-class correlation coefficients. The initial search yielded 4855 articles, narrowed to 15 after full-text review. Studies varied in design, patient populations, and diagnostic criteria, complicating direct comparison of modalities.
Key Findings
IH prevalence rates reported in literature vary widely between 10% and 32%, influenced by diagnostic modality and definition used.
Physical examination alone may underdetect IH compared to imaging modalities, but not all studies confirm increased detection with imaging.
CT-scan and ultrasound are recommended by guidelines for follow-up in research, yet their use in routine clinical practice is less consistent.
Definitions of IH differ, with some including any abdominal wall gap or bulge, while others require imaging confirmation, affecting reported prevalence.
Diagnostic protocols vary, with some studies using imaging only after inconclusive physical exams, others relying solely on radiologic confirmation.
Evidence on the diagnostic accuracy and reliability of different modalities remains limited and sometimes contradictory.
Clinical Implications
Clinicians should be aware that the choice of diagnostic modality and IH definition significantly impact detection rates. Incorporating imaging techniques such as ultrasound or CT-scan may improve diagnostic accuracy, especially in research settings. Standardization of diagnostic protocols and definitions is essential to ensure consistent IH diagnosis and comparability across studies.
Conclusion
The diagnostic approach to incisional hernia after abdominal surgery varies widely, influencing reported prevalence and detection rates. Further research is needed to clarify the accuracy and reliability of different modalities and to standardize diagnostic criteria for IH.
References
European Hernia Society Guidelines -- Closure of Abdominal Walls
Korenkov et al. -- Definition of Incisional Hernia
