Page 97 - Prevention and Treatment of Incisional Hernia- New Techniques and Materials

EHS guidelines
5
95
Table 2. Summary of Findings table for Key Question A: which diagnostic modality is
the most suitable to detect incisional hernias?
Bibliographic Study type SIGN Number citation assessment of
Patient characteristics
Intervention Comparison Length of Outcome measure follow-up
patients Baucom et al. prospective High Quality 181
patients seen at a general surgery department who had a prior abdominal operation and an available CT scan within six months before the visit
Physical CT scan not Physical examination had a low
Journal of the American College of Surgeons 2013; 218(3):363- 6.
cohort study
++
examination by a surgeon
reviewed by surgeon
available
sensitivity (77%)and negative
General comments: Adequate designed study to compare the sensitivity analysis.
physical examination to
CT scan diagnosis of incisional hernias. CT scan was used a “gold standard” for dynamic CT scan not Dynamic Ultrasound has a high
Beck et al. prospective High Quality 181
patients seen at a general surgery department who had a prior abdominal operation and an available CT scan within six months before the visit
Journal of the American College of Surgeons 2013;216(3):447- 53
cohort study
++
abdominal ultrasound by surgeon
reviewed by surgeon
available
sensitivity (98%) and speci city (88%). It has a positive predictive value of 91 % and negative predictive value of 97%. It is
a good alternative to CT scan diagnosis.
General comments: Paper from the same group as Baucom to CT scan diagnosis of incisional hernias. CT scan was used
et al. Concerns the same a “gold standard” for the
patient population. Adequate designed study to compare dynamic ultrasound sensitivity analysis.
den Hartog et al. prospective High Quality 40
patients that had aortic surgery by midline incision at least 12 months before
Ultrasound CT scan (by 2 mean 3.4 Incisional hernia prevalence
Hernia 2009;13(1):45-8
cohort study
++
by radiologist
independent radiologists.
years
was 60.0% with CT scan and 42.5% with ultrasound. The sensitivity of US was 70.8% and the speci city 100%. Us has a positive predictive value of 100% and a negative predictive value of 69.6%.
CT scan diagnosis of the incisional hernias has a good intra- and inter -observer reliability.
predictive value (77%). It fails to detect 23% of hernias and in 32% of the patients with a BMI ≥ 30 kg/m2.