The role of CT-based volumetric analysis of abdominal wall anatomy in predicting tension-free midline approximation in abdominal wall reconstruction with components separation. A pilot study.

Mazen Al-Mansour, MD, Greg Gagnon, MS, Alexander B Knee, MS, Sheina Theodore, MD, Jacqueline J Wu, MD, John Romanelli, MD, Neal E Seymour, MD. Baystatea Medical Center-University of Massachusetts Medical School

Objective: To evaluate the ability of abdominal wall volume measurements based on 3D-reconstruction of abdominal CT-scans to predict tension-free midline approximation (TFMA) in patients undergoing abdominal wall reconstruction with components separation (AWRCS).We hypothesized that CT-based volume measurements can better predict TFMA compared to linear measurements (e.g. defect width).

Methods: In this pilot study, we retrospectively reviewed the charts of 18 patients who underwent AWRCS (Nov 2008-Aug 2017). We collected demographic, historical, hernia-specific and operative data. Linear measurements were obtained from CT images and used to calculate the hernia sac volume (HSV) and abdominal cavity volume (ACV). 3D-reconstruction was performed to measure the HSV and ACV (Figure 1). Logistic regression analysis was used to determine how well clinical and CT parameters discriminated failure of TFMA. Pearson correlation was used to evaluate the agreement between calculated and measured parameters.

Results: Mean age was 55.9(10.9) years, 6 patients were female. Tables 1 and 2 and Figure 2 summarize the results.

Conclusions: Among the variables assessed in this pilot study, measured HSV/ACV ratio using 3D CT reconstruction was more predictive of TFMA than calculated volumes and linear measures (e.g. defect width).  There was good agreement between measured and calculated values of HSV, ACV and HSV/ACV. The findings of this pilot study need to be further investigated with a larger sample size.

	TFMA (N=15)	Failure of TFMA (N=3)	Total (N=18)	AUC
BMI (Kg/cm^2)*	35.6(9.4)	36.4(3.6)	35.8(8.6)	0.58
Recurrent hernia	8(53.3%)	2(66.7%)	10(55.6%)	0.57
Stoma present	1(6.7%)	1(33.3%)	2 (11.1%)	0.63
Defect width (cm)*	13.6(90.6)	13.4(4.0)	13.5 (4.1)	0.53
Calculated HSV/ACV ratio*	0.07(0.06)	0.09(0.07)	0.08(0.06)	0.60
Measured HSV/ACV ratio*	0.05(0.04)	0.10(0.07)	0.06(0.05)	0.76
* mean (SD) AUC area under the curve

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Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 95441

Program Number: P548

Presentation Session: Poster Session (Non CME)

Presentation Type: Poster

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