Clinical Scorecard: Evaluating Various Diagnostic Approaches for Incisional Hernia: A Systematic Review

At a Glance

Key Highlights

• IH prevalence varies widely (10-32%) influenced by factors like age, obesity, and prior surgery.
• Diagnostic modalities include physical exam, ultrasound, CT-scan, MRI, and per-operative diagnosis.
• Use of imaging (ultrasound or CT) is recommended in research for reliable IH detection but differs from routine clinical practice.

Guideline-Based Recommendations

Diagnosis

• Use ultrasound or CT-scan in follow-up of prospective IH studies as per European Hernia Society guidelines.
• Physical examination remains primary in clinical practice focusing on symptomatic IH requiring treatment.
• Definition of IH includes any abdominal wall gap with or without bulge detectable by clinical exam or imaging.

Management

• Treatment decisions generally based on symptomatic IH diagnosis.
• Imaging reserved for inconclusive physical exams or research confirmation.

Monitoring & Follow-up

• Follow-up protocols vary; imaging modalities improve detection reliability in research settings.
• Diagnostic protocols differ in use of imaging and clinical examination.

Risks

• Variability in IH detection rates due to differences in diagnostic modality, observer, and definition.
• Potential bias in studies due to inconsistent diagnostic criteria and protocols.

Patient & Prescribing Data

Patients post open abdominal or IH repair surgery monitored for IH development

Diagnostic accuracy varies by modality; imaging may increase detection but evidence is limited and sometimes contradictory

Clinical Best Practices

• Standardize IH definition and diagnostic protocols to improve comparability across studies.
• Incorporate imaging modalities, especially ultrasound or CT, in research follow-up to enhance detection accuracy.
• Use physical examination as initial diagnostic tool in clinical practice, reserving imaging for unclear cases.
• Consider patient factors (e.g., obesity) that may affect diagnostic performance of modalities.
• Assess inter-observer variability and ensure training to improve diagnostic reliability.

References

• European Hernia Society guidelines on abdominal wall closure
• Korenkov et al. definition of incisional hernia
• PROSPERO registration CRD42017062307
• PRISMA statement for systematic reviews