Skip to main content

Pilot study on objective measurement of abdominal wall strength in patients with ventral incisional hernia

Abstract

Background

Outcomes after ventral incisional hernia (VIH) repair are measured by recurrence rate and subjective measures. No objective metrics evaluate functional outcomes after abdominal wall reconstruction. This study aimed to develop testing of abdominal wall strength (AWS) that could be validated as a useful metric.

Methods

Data were prospectively collected during 9 months from 35 patients. A total of 10 patients were evaluated before and after VIH repair, for a total of 45 encounters. The patients were tested simultaneously or in succession by two of three examiners. Data were collected for three tests: double leg lowering (DLL), trunk raising (TR), and supine reaching (SR). Raw data were compared and tested for validity, and continuous data were transformed to categorical data. Agreement was measured using the intraclass correlation coefficient (ICC) for DLL and using kappa for the ordinal measures.

Results

Simultaneous testing yielded the following interobserver reliability: DLL (0.96 and 0.87), TR (1.00 and 0.95), and SR (0.76). Reproducibility was assessed by consecutive tests, with correlation as follows: DLL (0.81), TR (0.81), and RCH (0.21). Due to poor interobserver reliability for the SR test compared with the DLL and TR tests, the SR test was excluded from calculation of an overall score. Based on raw data distribution from the DLL and TR tests, the DLL data were categorized into 10º increments, allowing construction of a 10-point score. The median AWS score was 5 (interquartile range [IQR], 4–7), and there was agreement within 1 point for 42 of the 45 encounters (93%).

Conclusions

The findings from this study demonstrate that the 10-point AWS score may measure AWS in an accurate and reproducible fashion, with potential for objective description of abdominal wall function of VIH patients. This score may help to identify patients suited for abdominal wall reconstruction while measuring progress after VIH repair. Further longitudinal outcomes studies are needed.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3

References

  1. Park A, Birch DW, Lovrics P (1998) Laparoscopic and open incisional hernia repair: a comparison study. Surgery 124:816–821 (discussion 821–822)

    PubMed  Article  CAS  Google Scholar 

  2. Ramshaw BJ, Esartia P, Schwab J, Mason EM, Wilson RA, Duncan TD, Miller J, Lucas GW, Promes J (1999) Comparison of laparoscopic and open ventral herniorrhaphy. Am Surg 65:827–831 (discussion 831–832)

    PubMed  CAS  Google Scholar 

  3. Rosen M, Garcia-Ruiz A, Malm J, Mayes JT, Steiger E, Ponsky J (2001) Laparoscopic hernia repair enhances early return of physical work capacity. Surg Laparosc Endosc Percutan Tech 11:28–33

    PubMed  CAS  Google Scholar 

  4. Lejour M, Dome M (1991) Abdominal wall function after rectus abdominis transfer. Plast Reconstr Surg 87:1054–1068

    PubMed  Article  CAS  Google Scholar 

  5. Mizgala CL, Hartrampf CR Jr, Bennett GK (1994) Assessment of the abdominal wall after pedicled TRAM flap surgery: 5- to 7-year follow-up of 150 consecutive patients. Plast Reconstr Surg 93:988–1002 (discussion 1003–1004)

    PubMed  Article  CAS  Google Scholar 

  6. Kind GM, Rademaker AW, Mustoe TA (1997) Abdominal-wall recovery following TRAM flap: a functional outcome study. Plast Reconstr Surg 99:417–428

    PubMed  Article  CAS  Google Scholar 

  7. Dulin WA, Avila RA, Verheyden CN, Grossman L (2004) Evaluation of abdominal wall strength after TRAM flap surgery. Plast Reconstr Surg 113:1662–1665 (discussion 1666–1667)

    PubMed  Article  Google Scholar 

  8. Zauner-Dungl A, Resch KL, Herczeg E, Piza-Katzer H (1995) Quantification of functional deficits associated with rectus abdominis muscle flaps. Plast Reconstr Surg 96:1623–1628

    PubMed  Article  CAS  Google Scholar 

  9. Moreland J, Finch E, Stratford P, Balsor B, Gill C (1997) Interrater reliability of six tests of trunk muscle function and endurance. J Orthop Sports Phys Ther 26:200–208

    PubMed  CAS  Google Scholar 

  10. Youdas JW, Garrett TR, Egan KS, Therneau TM (2000) Lumbar lordosis and pelvic inclination in adults with chronic low back pain. Phys Ther 80:261–275

    PubMed  CAS  Google Scholar 

  11. Krause DA, Youdas JW, Hollman JH, Smith J (2005) Abdominal muscle performance as measured by the double leg-lowering test. Arch Phys Med Rehabil 86:1345–1348

    PubMed  Article  Google Scholar 

  12. Magee DJ (2008) Orthopedic physical assessment, 5th edn. Saunders Elsevier, St. Louis

    Google Scholar 

  13. Kendall FP (1983) Muscles, testing and function, 3rd edn. Williams & Wilkins, Baltimore

    Google Scholar 

  14. Reese NB (1999) Muscle and sensory testing, 2nd edn. WB Saunders Co, Philadelphia

    Google Scholar 

  15. Clarkson HM (2000) Musculoskeletal assessment: joint range of motion and manual muscle strength, 2nd edn. Lippincott Williams & Wilkins, Philadelphia

    Google Scholar 

Download references

Acknowledgments

We acknowledge Ms. Barbara J. Williams for her assistance in formatting the figures used in this report.

Disclosures

Michael Parker, Ross F. Goldberg, Maryane M. Dinkins, Horacio J. Asbun, C. Daniel Smith, Susanne Preissler, and Steven P. Bowers have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Steven P. Bowers.

Additional information

Presented at the SAGES 2011 Annual Meeting, March 30–April 2, 2011, San Antonio, TX.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Parker, M., Goldberg, R.F., Dinkins, M.M. et al. Pilot study on objective measurement of abdominal wall strength in patients with ventral incisional hernia. Surg Endosc 25, 3503–3508 (2011). https://doi.org/10.1007/s00464-011-1744-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-011-1744-8

Keywords

  • Abdominal
  • Clinical papers/trials/research
  • Hernia
  • Plastic surgery
  • Statistical