Page 149 - Prevention and Treatment of Incisional Hernia- New Techniques and Materials

the median age was 66 (range 32 to 81), the median BMI was 25 (range 17 to 41), 10 patients (13%) had diabetes mellitus (DM), 10 (13%) had chronic obstructive pulmonary disease (COPD), 16 (21%) were current smokers and in 7 (9%), the colostomy was placed lateral to ARM. Older patients had a decrease in ARM thickness (rs= -0.28 preoperatively, rs= - 0.25 postoperatively); also, in female patients a general decrease in ARM thickness (p < 0.001) was observed. However, female sex and age did not have an e ect on the midline shift. DM, COPD, smoking and pararectal placement of the colostomy were also not associated with a change in ARM thickness or midline shift.
I-Space®
The median preoperative midline shift was -0.8mm (n=30; IQR -4.8 to 0.9). Postoperatively the median postoperative shift was 4.5 mm (n=77; IQR -1.9 - 9.8) corresponding with a shift to the right. Comparing the preoperative CT- scans with the CT-scans that were taken postoperatively, there was a mean shift to the right side; from -1.3 +/-4.6 to 2.1 +/-9.3) (p = 0.043) (Table 1).
ARM measurements
When comparing the preoperative CT-scans with the postoperative CT-scans a thickening of the left ARM was observed at 3cm cranial, 3cm caudal, and at the level of the colostomy (Table 1). This thickening of the ARM was not seen on the right/contralateral side.
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Table 1. Preoperative versus postoperative data.
Abdominal wall changes and IH
Midline shift at stoma
Left ARM (n = 30)
ARM thickness 8cm above stoma ARM thickness 3cm above stoma ARM thickness at stoma level ARM thickness 3cm below stoma ARM thickness 8cm below stoma Right ARM (n = 30)
ARM thickness 8cm above stoma ARM thickness 3cm above stoma ARM thickness at stoma level ARM thickness 3cm below stoma ARM thickness 8cm below stoma
Preoperative*
-1.3 (4.6)
8.1 (2.4) 8.8 (2.6) 9.1 (2.8) 9.6 (2.7) 10.8 (3.2)
8.3 (2.4) 8.9 (2.5) 9.3 (2.7) 9.9 (2.7) 10.9 (3.1)
Postoperative*
2.1 (9.3)
8.5 (2.1) 9.8 (2.6) 10.2 (2.5) 10.3 (2.7) 10.4 (3.2)
8.5 (2.6) 9.6 (3.1) 9.6 (2.7) 10.5 (3.3) 11.1 (3.5)
P-Value**
0.043
0.203 0.010 0.024 0.086 0.466
0.609 0.081 0.448 0.178 0.609
* Values represent the means and standard deviation in mm
** p-values are two-sided. For continuous variables the paired student t-test was used.
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