Postoperative Incision Hernia in Patients with Abdominal Aortic Aneurysm and Aortoiliac Occlusive Disease: A Systematic Review

Takagi, Hisato; Sugimoto, Masayuki; Kato, Takayoshi; Matsuno, Yukihiro; Umemoto, Takuya

doi:10.1016/j.ejvs.2006.07.009

Cited by 93 publications

(82 citation statements)

References 17 publications

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“…In comparison, the pooled analysis of Takagi et al yielded an incidence of 21% in a total of 719 abdominal aortic aneurysm reconstruction patients [8]. However, most of the diagnoses included in the analysis were made clinically.…”

Section: Discussionmentioning

confidence: 99%

“…For instance, in a study comparing US and magnetic resonance imaging (MRI), the incidence of incisional hernias was 31.7% after reconstruction for abdominal aortic aneurysm after a mean duration of follow-up of 48.6 months [7]. In a systematic literature review, the pooled incidence of a postoperative incision hernia was 21% in abdominal aortic aneurysm patients and 9.8% in patients with aortoiliac occlusive disease [8].…”

Section: Introductionmentioning

confidence: 99%

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Comparison of ultrasonography with computed tomography in the diagnosis of incisional hernias

Hartog

Dur

Kamphuis

et al. 2008

Hernia

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Background The objective of this study is to determine the reliability and validity of ultrasonography (US) in diagnosing incisional hernias in comparison with computed tomography (CT). The CT scans were assessed by two radiologists in order to estimate the inter-observer variation and twice by one radiologist to estimate the intra-observer variation. Patients were evaluated after reconstruction for an abdominal aortic aneurysm or an aortoiliac occlusion. Methods Patients with a midline incision after undergoing reconstruction of an abdominal aortic aneurysm or aortoiliac occlusion were examined by CT scanning and US. Two radiologists evaluated the CT scans independently. One radiologist examined the CT scans twice. Discrepancies between the CT observations were resolved in a common evaluation session between the two radiologists.Results After a mean follow-up of 3.4 years, 40 patients were imaged after a reconstructed abdominal aortic aneurysm (80% of the patients) or aortoiliac occlusion. The prevalence of incisional hernias was 24/40 = 60.0% with CT scanning as the diagnostic modality and 17/40 = 42.5% with US. The measure of agreement between CT scanning and US expressed as a Kappa statistic was 0.66 (95% conWdence interval [CI] 0.45-0.88). The sensitivity of US examination when using CT as a comparison was 70.8%, the speciWcity was 100%, the predictive value of a positive US was 100%, and the predictive value of a negative US was 69.6%. The likelihood ratio of a positive US was inWnite and that of a negative US was 0.29. The inter-and intraobserver Kappa statistics were 0.74 (CI 0.54-0.95) and 0.80 (CI 0.62-0.99), respectively. Conclusions US imaging has a moderate sensitivity and negative predictive value, and a very good speciWcity and positive predictive value. Consistency of diagnosis, as determined by calculating the inter-and intra-observer Kappa statistics, was good. The incidence of incisional hernias is high after aortic reconstructions.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of ultrasonography with computed tomography in the diagnosis of incisional hernias

Hartog

Dur

Kamphuis

et al. 2008

Hernia

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“…[10][11][12][13][14][15][16][17] If the reverse association were true (i.e. if hernias were a risk factor for AAAs), then the presence of a hernia could be used to select higher risk patients and, therefore, increase the effectiveness of a screening programme.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Abdominal Aortic Aneurysms in Over 65-Year-Old Men with Inguinal Hernias

Anderson

Shiralkar

2008

annals

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Ann R Coll Surg Engl 2008; 90: 386-388 386Acute rupture of an abdominal aortic aneurysm (AAA) accounts for 2% of mortality in over 60-year-old men. 1 Emergency AAA repair at the time of rupture has a mortality of approximately 75% and elective AAA repair before rupture has a mortality of approximately 5%. 2Screening programmes attempt to detect asymptomatic AAAs in order to repair them electively before rupture occurs.Age and sex are the only AAA risk factors that are currently used to select a population to be invited for screening. It has been shown that a history of an inguinal hernia repair is a risk factor for AAA and that selectively screening over 65-year-old men with inguinal hernias pre-operatively may detect more AAAs than conventional screening programmes. This study aimed to confirm whether pre-operative screening of male patients over the age of 65 years, who have an inguinal hernia, detected a significantly increased prevalence of AAA compared with the results of screening programmes using only age and sex to select their populations. Patients and MethodsThis study was calculated to require n = 70 to be able to achieve a power of 86% if the expected prevalence = 12% and the control prevalence = 3% (alpha = 0.05, one-tailed, exact method).Seventy consecutive male patients aged 65 years and older who were referred to the out-patient clinic of a single vascular surgeon with an inguinal hernia between June 2004 and March 2007 underwent ultrasound examination of the abdominal aorta in the supine position. The variety of ultrasound machines (one Siemens Sonoline Antares, two Hitachi EUB 8500 and two EUB 5500) and ultrasonographers was not limited for this study. ResultsThe age range of the study population was 65-88 years (mean, 74 years; mode, 66 years; median, 73 years; 95% confidence interval [CI],[73][74][75]. Ultrasound scan results were <2 .5 cm in any transverse section in 64 cases (91%), ectatic (2.5-3 cm in any transverse section) in 3 cases (4%), aneurysmal (≥ 3c m in any transverse section or dilated ≥ 50% than the proximal aorta) in two cases that measured 3.8 cm and 6.0 cm (3%) and occluded in one case (1.4%). This gives an AAA prevalence of 3% (normal 95% CI, -1 to 7%, exact 95% CI, 0-10%).

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“…A recent systematic review found that patients with AAA had a 2.9-fold (95% confidence interval 1.71-4.77, P < 0.0001) increased risk if inguinal hernia and a 2.8-fold increased risk of incisional hernia (1.88-4.13, P < 0.0001) compared with patients with aorto-iliac occlusive disease. 4 While I accept that incisional and inguinal hernias are clearly different, these data do seem to add greater weight to an underlying connective tissue abnormality, or their biological response to important co-factors, such as smoking, in this challenging group of patients. 2 operation, the testis was lying beneath Buck's fascia, in the shaft of penis.…”

Section: Images For Surgeons: Abdominal Aortic Aneurysm Inguinal Hermentioning

confidence: 99%

Traumatic ectopic testis

Yagnik

2009

ANZ Journal of Surgery

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Postoperative Incision Hernia in Patients with Abdominal Aortic Aneurysm and Aortoiliac Occlusive Disease: A Systematic Review

Abstract: Patients with abdominal aortic aneurysm appear to have an approximately 3-fold increased risk for both inguinal and postoperative incision hernia compared to patients with aortoiliac occlusive disease. A large multi-centre prospective study is needed to confirm the results of this review.

Cited by 93 publications

References 17 publications

Comparison of ultrasonography with computed tomography in the diagnosis of incisional hernias

Comparison of ultrasonography with computed tomography in the diagnosis of incisional hernias

Prevalence of Abdominal Aortic Aneurysms in Over 65-Year-Old Men with Inguinal Hernias

Traumatic ectopic testis

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