BACKGROUND: Surgeon physical examination is often used to monitor for hernia recurrence in clinical and research settings, despite a lack of information on its effectiveness. This study aims to compare surgeon-reviewed CT with surgeon physical examination for the detection of incisional hernia. STUDY DESIGN: General surgery patients with an earlier abdominal operation and a recent viewable CT scan of the abdomen and pelvis were enrolled prospectively. Patients with a stoma, fistula, or soft-tissue infection were excluded. Surgeon-reviewed CT was treated as the gold standard. Patients were stratified by body mass index into nonobese (body mass index <30) and obese groups. Testing characteristics and real-world performance, including positive predictive value and negative predictive value, were calculated. RESULTS: One hundred and eighty-one patients (mean age 54 years, 68% female) were enrolled. Hernia prevalence was 55%. Mean area of hernias was 44.6 cm(2). Surgeon physical examination had a low sensitivity (77%) and negative predictive value (77%). This difference was more pronounced in obese patients, with sensitivity of 73% and negative predictive value 69%. CONCLUSIONS: Surgeon physical examination is inferior to CT for detection of incisional hernia, and fails to detect approximately 23% of hernias. In obese patients, 31% of hernias are missed by surgeon physical examination. This has important implications for clinical follow-up and design of studies evaluating hernia recurrence, as ascertainment of this result must be reliable and accurate.
BACKGROUND: Surgeon physical examination is often used to monitor for hernia recurrence in clinical and research settings, despite a lack of information on its effectiveness. This study aims to compare surgeon-reviewed CT with surgeon physical examination for the detection of incisional hernia. STUDY DESIGN: General surgery patients with an earlier abdominal operation and a recent viewable CT scan of the abdomen and pelvis were enrolled prospectively. Patients with a stoma, fistula, or soft-tissue infection were excluded. Surgeon-reviewed CT was treated as the gold standard. Patients were stratified by body mass index into nonobese (body mass index <30) and obese groups. Testing characteristics and real-world performance, including positive predictive value and negative predictive value, were calculated. RESULTS: One hundred and eighty-one patients (mean age 54 years, 68% female) were enrolled. Hernia prevalence was 55%. Mean area of hernias was 44.6 cm(2). Surgeon physical examination had a low sensitivity (77%) and negative predictive value (77%). This difference was more pronounced in obesepatients, with sensitivity of 73% and negative predictive value 69%. CONCLUSIONS: Surgeon physical examination is inferior to CT for detection of incisional hernia, and fails to detect approximately 23% of hernias. In obesepatients, 31% of hernias are missed by surgeon physical examination. This has important implications for clinical follow-up and design of studies evaluating hernia recurrence, as ascertainment of this result must be reliable and accurate.
Authors: Salvatore A Giordano; Patrick B Garvey; Donald P Baumann; Jun Liu; Charles E Butler Journal: Plast Reconstr Surg Date: 2017-05 Impact factor: 4.730
Authors: Deepa V Cherla; Maya L Moses; Cristina P Viso; Julie L Holihan; Juan R Flores-Gonzalez; Lillian S Kao; Tien C Ko; Mike K Liang Journal: World J Surg Date: 2018-01 Impact factor: 3.352
Authors: T Kaneko; K Funahashi; M Ushigome; S Kagami; M Goto; T Koda; Y Nagashima; H Shiokawa; J Koike Journal: Hernia Date: 2018-11-13 Impact factor: 4.739
Authors: A Balaphas; N C Buchs; S P Naiken; M E Hagen; A Zawodnik; M K Jung; G Varnay; L H Bühler; P Morel Journal: Hernia Date: 2017-05-09 Impact factor: 4.739
Authors: F E Muysoms; S A Antoniou; K Bury; G Campanelli; J Conze; D Cuccurullo; A C de Beaux; E B Deerenberg; B East; R H Fortelny; J-F Gillion; N A Henriksen; L Israelsson; A Jairam; A Jänes; J Jeekel; M López-Cano; M Miserez; S Morales-Conde; D L Sanders; M P Simons; M Śmietański; L Venclauskas; F Berrevoet Journal: Hernia Date: 2015-01-25 Impact factor: 4.739
Authors: M Widmar; M Keskin; P Beltran; G M Nash; J G Guillem; L K Temple; P B Paty; M R Weiser; J Garcia-Aguilar Journal: Hernia Date: 2016-07-28 Impact factor: 4.739