Abstract
Background
Recurrent ventral hernia repair can be challenging due to scarred tissue planes and the increasing complexity of disease related to multiple recurrences. Given the challenges of acquiring complete and accurate prior operative reports, surgeons often rely on computed tomography (CT) scans to obtain information and plan for re-operation. Still, the contribution of CT scans and the ability of surgeons to interpret them is controversial. Previously, we examined the ability of surgeons to determine prior operative techniques based on CT scans. Here, we assessed the accuracy of expert abdominal wall reconstruction (AWR) surgeons in identifying the type of prior mesh using CT imaging.
Methods
A total of 22 highly experienced AWR surgeons were asked to evaluate 21 CT scans of patients who had undergone open ventral hernia repair with bilateral transversus abdominis release utilizing mesh. The surgeons were required to identify the mesh type from a multiple-choice selection. Additionally, negative controls (patients without a history of prior laparotomy) and positive controls (patients with laparotomy but no ventral hernia repair) were incorporated. The accuracy of the surgeons and interrater reliability was calculated.
Results
The accuracy rate of the surgeons in correctly identifying the mesh type was 46%, with heavy-weight synthetic mesh (HWSM) being identified only 35.4% of the time, Strattice mesh and medium-weight synthetic mesh (MWSM) were identified at 46.3%, and 51.8%, respectively. The interrater reliability analysis found a moderate level of agreement 0.428 (95% CI 0.356–0.503), and the repeatability measure was poor—0.053 (95% CI 0–0.119); this indicates that surgeons cannot reliably replicate the identification process.
Conclusions
Surgeons’ ability to accurately identify the type of previous mesh using CT scans is poor. This study underscores the importance of documenting the type of mesh used in the operative report and the need for standardized operative notes to improve the accuracy and consistency of documentation.
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Data availability
The data supporting the findings of this study are available upon request from the corresponding author, Nir Messer, under reasonable conditions.
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Acknowledgments
The authors extend their gratitude to the skilled abdominal wall reconstruction surgeons who contributed to this study.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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All the authors contributed to the study’s conception and design. Material preparation and data collection were performed by NM. The initial drafts of the manuscript were written by NM and ASP. All the authors commented on and revised the manuscript. All the authors read and approved the final manuscript. Ajita S Prabhu supervised the study.
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The authors declare that there are no conflicts of interest related to this manuscript. The study was conducted impartially, and the findings presented in the manuscript are based solely on the analysis and interpretation of the data. Informed consent not required: As the study did not involve human patients or participants, no informed consent was necessary. The data utilized in this research were collected and analyzed in a manner that ensures the privacy and confidentiality of individuals and adheres to the relevant ethical guidelines and regulations. Conflict of interest 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 no declarations. L.R.B has received honorarium from Intuitive.
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The research was conducted in accordance with the ethical principles outlined in Institutional Review Board. The use of data and materials was carried out with proper authorization and in compliance with all applicable laws and regulations.
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In adherence to ethical standards, this chart review study, though devoid of direct human or animal involvement, maintained patient data confidentiality and ethical standards as required by the institutional review board.
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As this study involved the use of existing data and did not involve direct interaction with human subjects, no patients were enrolled, and therefore, no informed consent was required. The data used in this research were anonymized and de-identified, ensuring the privacy and confidentiality of individuals in accordance with the Institutional Review Board.
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Messer, N., Melland, M.S., Miller, B.T. et al. Can surgeons accurately identify mesh type when interpreting computed tomography scans after ventral hernia repair?. Hernia (2024). https://doi.org/10.1007/s10029-024-03024-w
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DOI: https://doi.org/10.1007/s10029-024-03024-w