O. A. OLAVARRIA1, K. Bernardi1, A. Milton1, N. B. Lyons1, P. Shah1, T. C. Ko1, L. S. Kao1, M. K. Liang1 1McGovern Medical School at UTHealth,General Surgery,Houston, TX, USA
Introduction:
Two thirds of all Americans are overweight or obese and one half will receive a computed tomography (CT) scan in their lifetime. With the growing obesity epidemic and widespread use of advanced imaging there is a pressing need to quantify the prevalence and impact of hernias among these individuals. Our aim was to determine the prevalence of abdominal wall hernias (clinical and radiographic) among patients undergoing CT scans and their impact on patients’ quality of life.
Methods:
Consecutive patients undergoing elective CT scans of abdomen/pelvis from a single institution were enrolled. In general, CT scans were performed with oral and intravenous contrast with 5 mm cuts. Brief history was obtained in the radiology suite and quality of life (QoL) was measured through the modified Activities Assessment Scale, a validated, hernia-specific survey. On this scale, 1 is poor QoL and 100 is perfect; a change of 7 is the minimum clinically important difference. Standardized abdominal and groin examinations were performed by a surgeon blinded to the CT scan results. Three surgeons blinded to the results of the physical examination reviewed the CT scans for the presence of ventral or groin hernias. The number of patients and their QoL scores were determined for four groups of patients: no hernia, clinical or radiographic hernias, clinically apparent hernias, and occult hernias or hernias only seen on radiographic imaging. Pairwise differences between groups were compared using a Mann-Whitney U test.
Results:
A total of 246 patients were enrolled of whom 76 (30.8%) were overweight and 105 (42.6%) were obese. Physical examination detected a ventral hernia in 50 (20.3%) patients and a groin hernia in 17 (6.9%) patients while CT scan revealed 128 (52.0%) and 64 (26.0%) respectively. Of patients with a hernia on CT scan, 85 (34.5%) had an occult ventral hernia and 40 (16.2%) had an occult groin hernia. The QoL, median (IQR), of patients with no clinical or radiographic hernia was 84 (46), while the QoL of those with a clinical hernia was 62 (55) and 77 (57) among those with an occult hernia (Table).
Conclusion:
In the era of the obesity-epidemic and widespread use of radiographic imaging, hernias are extremely common. One fourth of individuals undergoing CT abdomen and pelvis scans have a clinical hernia while over 40% have an occult hernia. These hernias have a substantial impact on an individual’s QoL. Compared to individuals with no hernias, patients with a clinically apparent hernia and patients with occult hernias have significantly lower median QoL (by 22 and 7 points respectively). Randomized trials are needed to determine if operative repair can result in a clinically significant improvement in QoL.
