Abstract
Background
Recurrent ventral hernia repair can be complex and requires a thorough understanding of prior interventions, myofascial releases, and location of prosthetic material. Without detailed operative reports, this information can be challenging to obtain, and some surgeons have suggested prior operative details can be discerned from radiographic imaging. We evaluated the accuracy and interrater reliability of surgeons to identify the type of prior VHR using CT imaging.
Methods
Fifteen expert abdominal wall reconstruction surgeons individually reviewed 21 CT scans of patients after various VHR approaches and determined the approach from a multiple-choice selection. Negative controls (no prior laparotomy) and positive controls (laparotomy without VHR) were also included. Surgeon accuracy and interrater reliability were measured.
Results
Surgeons were unable to identify the correct VHR over 50% of the time: open TAR and Rives–Stoppa were identified 42% of the time, open anterior component separation 24%, and robotic IPOM and eTEP 22% of the time, respectively. Surgeon interrater reliability, or agreement on answers—whether correct or incorrect—was fair (coefficient 0.23, p = 0.01).
Conclusions
Surgeons’ ability to accurately identify the type of previous VHR using post-operative CT scans is poor. Without the knowledge of prior repairs, surgeons may find it difficult to choose the best reoperative approach, anticipate operative complexities, and schedule appropriate OR time. All of which guides patient counseling and expectations. This highlights the importance to accurately reflect VHR details in operative reports and use necessary resources to obtain operative reports, since surgeons cannot reliably use CT scans to identify prior repairs.
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Acknowledgements
We appreciate the expert abdominal wall reconstruction surgeons who participated in this study. We also appreciate our statistician, Chao Tu, who performed all statistical analyses. This research did not receive any grant from funding agencies in the public, commercial, or not-for-profit sectors.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. David M. Krpata has received an educational grant from W.L. Gore, which is not related to the present work. Ajita S. Prabhu receives personal fees from Medtronic and Intuitive Surgical Inc. and has an ongoing research grant from Intuitive Inc. Michael J. Rosen receives salary support for his leadership position in the ACHQC, is a board member, and has stock/stock options from Ariste Medical. Clayton C. Petro has received funding paid to his institution from the Americas Hernia Society, Central Surgical Society, and Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). Lucas R. Beffa has received honorarium from Intuitive Surgical Inc. None of which was related to the present work.
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All of the authors contributed to the study conception and design. Material preparation and data collection were performed by KEB. The initial drafts of the manuscript were written by KEB and MJR. All of the authors commented and revised the manuscript. All of the authors read and approved the final manuscript. The study was supervised by MJR.
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M.J.R. receives salary support for his position in the leadership of the Abdominal Core Health Quality Collaborative (ACHQC), which is the data source for the present submission; and he receives board member support and stock options from Ariste Medical. A.S.P. has received funding paid to her institution from Intuitive Surgical Inc., personal fees from Medtronic, Intuitive Surgical, CMR Surgical, and Verb Surgical. D.M.K. has received funding paid to his institution from W.L Gore. C.C.P. has received funding paid to his institution from the Americas Hernia Society, Central Surgical Society, and Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). L.R.B has received honorarium from Intuitive Surgical Inc. K.E.B declares that she has no conflicts of interest.
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Blake, K.E., Beffa, L.R., Petro, C.C. et al. Surgeon accuracy and interrater reliability when interpreting CT scans after ventral hernia repair. Hernia 27, 347–351 (2023). https://doi.org/10.1007/s10029-022-02710-x
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DOI: https://doi.org/10.1007/s10029-022-02710-x