CT Findings Associated with the Risk for Emergency Ventral Hernia Repair

• Published in: The American journal of surgery 2016
• Main Authors: Mueck, Krislynn M., MD, MPH, Holihan, Julie L., MD, Mo, Jiandi, MS, Flores-Gonzales, Juan R., MD, Ko, Tien C., MD, Kao, Lillian S., MD, MS, Liang, Mike K., MD
• Format: Article
• Language: English
• Subjects: Surgery
• ISSN: 0002-9610
• DOI: 10.1016/j.amjsurg.2016.09.035

Abstract Background Conventional wisdom teaches that small hernia defects are more likely to incarcerate. We aim to identify radiographic features of ventral hernias associated with increased risk of bowel incarceration. Methods We assessed all patients who underwent emergent ventral hernia repair for bowel complications from 2009-2015. Cases were matched 1:3 with elective controls. CT scans were reviewed to determine hernia characteristics. Univariate and multivariable analyses were performed to identify variables associated with emergent surgery. Results The cohort consisted of 88 patients and 264 controls. On univariate analysis, older age, higher ASA score, elevated BMI, ascites, larger hernias, small angle, and taller hernias were associated with emergent surgery. On multivariable analysis, morbid obesity, ascites, smaller angle, and taller hernias were independently associated with emergent surgery. Conclusions The teaching that large defects do not incarcerate is inaccurate; bowel compromise occurs with ventral hernias of all sizes. Instead, taller height and smaller angle are associated with the need for emergent repair. Early elective repair should be considered for patients with hernia features concerning for increased risk of bowel compromise.