Patterns of Deterioration and Improvement in Abdominal Wall Function After Ventral Incisional Hernia Repair: Results of a Prospective Study

Ross F Goldberg, MD, Armando Rosales-velderrain, MD, Tatyan M Clarke, MD, Michael Parker, MD, Madi Dinkins, Mauricia A Buchanan, RN, John A Stauffer, MD, Horacio J Asbun, MD FACS, C Daniel Smith, MD FACS, Steven P Bowers, MD FACS. Mayo Clinic – Florida

Introduction:
Using our previously validated and reported abdominal wall strength score (AWSS), our aim was to objectively measure improvement in abdominal wall function after ventral incisional hernia (VIH) repair.

Methods and Procedures:
Between December 2009 and September 2011 56 patients undergoing VIH repair were enrolled in a prospective study assessing AWSS preoperatively and at 4 month intervals postoperatively for up to 12 months. The AWSS is a physical exam-based measure of double leg lowering and trunk raising. Each movement was graded on a 5-point scale, with a maximum score of 10. A significant AWSS change was considered any change of 2 points or more, and higher scores indicate better abdominal wall function. Thirty-three patients were eligible for 8-12 month follow-up; 4 patients did not complete the follow-up assessments, yielding an 88% retention rate (n=29). Average patient age was 63.0 +/- 13.3 years and the majority of patients were male (n=18). Nineteen patients underwent laparoscopic repair and 10 open repair.

Results:
No patient developed a hernia recurrence. The median and interquartile range (IQR) of AWSS for the 29 patients are: preoperative, 4 (IQR: 4-6); 4-month, 4 (IQR: 4-6); 8-month, 5 (IQR: 5-7); and 12-month, 7 (IQR: 6-8, p=0.0014 compared to preoperative, Mann-Whitney U test). At four months after repair, 8 of 29 patients (28%) had ≥2 point reduction of AWSS when compared to their preoperative score. After 8-12 months, 15 patients (51.7%) had ≥2 point increase of AWSS when compared to their preoperative score, 12 (41.4%) were unchanged and 2 (6.9%) had ≥2 point reduction. There was no statistical difference between laparoscopic and open approaches in overall AWSS improvement or in number of patients with deterioration at 4 months.

Conclusion:
There is a measurable improvement in abdominal wall strength in patients undergoing VIH repair. In many patients, there is a considerable decrease in abdominal wall function at 4 months after operation. The AWSS score shows promise for comparing outcomes using different VIH repair techniques.

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