Computed tomography for evaluation of abdominal wall hernias-what is the value of the Valsalva maneuver?

IF 2.6 2区医学 Q1 SURGERY

Hernia Pub Date : 2024-10-01 Epub Date: 2024-06-14 DOI:10.1007/s10029-024-03036-6

S Ghafoor, A T Hoppe, M Lange, A Tognella, M Bueter, K Lehmann, H Alkadhi, D Stocker

{"title":"Computed tomography for evaluation of abdominal wall hernias-what is the value of the Valsalva maneuver?","authors":"S Ghafoor, A T Hoppe, M Lange, A Tognella, M Bueter, K Lehmann, H Alkadhi, D Stocker","doi":"10.1007/s10029-024-03036-6","DOIUrl":null,"url":null,"abstract":"Purpose: To investigate the differences in the visibility and size of abdominal wall hernias in computed tomography (CT) with and without Valsalva maneuver.Methods: This single-center retrospective study included consecutive patients who underwent abdominal CTs with Valsalva maneuver between January 2018 and January 2022. Inclusion criteria was availability of an additional non-Valsalva CT within 6 months. A combined reference standard including clinical and surgical findings was used. Two independent, blinded radiologists measured the hernia sac size and rated hernia visibility on CTs with and without Valsalva. Differences were tested with a Wilcoxon signed rank test and McNemar's test.Results: The final population included 95 patients (16 women; mean age 46 ± 11.6 years) with 205 hernias. Median hernia sac size on Valsalva CT was 31 mm compared with 24 mm on non-Valsalva CT (p < 0.001). In 73 and 82% of cases, the hernias were better visible on CT with Valsalva as compared to that without. 14 and 17% of hernias were only visible on the Valsalva CT. Hernia visibility on non-Valsalva CT varied according to subtype, with only 0 and 3% of umbilical hernias not being visible compared with 43% of femoral hernias.Conclusions: Abdominal wall hernias are larger and better visible on Valsalva CT compared with non-Valsalva CT in a significant proportion of patients and some hernias are only visible on the Valsalva CT. Therefore, this method should be preferred for the evaluation of abdominal wall hernias.","PeriodicalId":13168,"journal":{"name":"Hernia","volume":null,"pages":null},"PeriodicalIF":2.6000,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11449955/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Hernia","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s10029-024-03036-6","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/6/14 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"SURGERY","Score":null,"Total":0}

引用次数: 0

Abstract

Purpose: To investigate the differences in the visibility and size of abdominal wall hernias in computed tomography (CT) with and without Valsalva maneuver.

Methods: This single-center retrospective study included consecutive patients who underwent abdominal CTs with Valsalva maneuver between January 2018 and January 2022. Inclusion criteria was availability of an additional non-Valsalva CT within 6 months. A combined reference standard including clinical and surgical findings was used. Two independent, blinded radiologists measured the hernia sac size and rated hernia visibility on CTs with and without Valsalva. Differences were tested with a Wilcoxon signed rank test and McNemar's test.

Results: The final population included 95 patients (16 women; mean age 46 ± 11.6 years) with 205 hernias. Median hernia sac size on Valsalva CT was 31 mm compared with 24 mm on non-Valsalva CT (p < 0.001). In 73 and 82% of cases, the hernias were better visible on CT with Valsalva as compared to that without. 14 and 17% of hernias were only visible on the Valsalva CT. Hernia visibility on non-Valsalva CT varied according to subtype, with only 0 and 3% of umbilical hernias not being visible compared with 43% of femoral hernias.

Conclusions: Abdominal wall hernias are larger and better visible on Valsalva CT compared with non-Valsalva CT in a significant proportion of patients and some hernias are only visible on the Valsalva CT. Therefore, this method should be preferred for the evaluation of abdominal wall hernias.

Abstract Image

查看原文本刊更多论文

计算机断层扫描评估腹壁疝--瓦尔萨尔瓦手法的价值何在？

目的：研究有无瓦尔萨尔瓦手法的腹壁疝在计算机断层扫描（CT）中的可见度和大小差异：这项单中心回顾性研究纳入了 2018 年 1 月至 2022 年 1 月期间接受过 Valsalva 手法腹部 CT 检查的连续患者。纳入标准是在 6 个月内接受过一次额外的非 Valsalva CT 检查。采用包括临床和手术结果在内的综合参考标准。两名独立的盲人放射科医生分别测量了有Valsalva动作和无Valsalva动作的CT上的疝囊大小，并对疝的可见度进行了评分。差异检验采用 Wilcoxon 符号秩检验和 McNemar 检验：最终有 95 名患者（16 名女性；平均年龄 46 ± 11.6 岁）患有 205 个疝气。Valsalva CT 中位疝囊大小为 31 毫米，而非 Valsalva CT 中位疝囊大小为 24 毫米（P < 0.001）。分别有 73% 和 82% 的疝气在做 Valsalva CT 时比不做 Valsalva CT 时更明显。分别有 14% 和 17% 的疝气仅在 Valsalva CT 上可见。疝气在非 Valsalva CT 上的可见度因亚型而异，只有 0% 和 3% 的脐疝不可见，而股骨疝的可见度为 43%：相当一部分患者的腹壁疝在 Valsalva CT 上比在非 Valsalva CT 上更大更明显，有些疝只有在 Valsalva CT 上才能看到。因此，在评估腹壁疝时应首选这种方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Hernia SURGERY-

CiteScore

4.90

自引率

26.10%

发文量

171

审稿时长

4-8 weeks

期刊介绍： Hernia was founded in 1997 by Jean P. Chevrel with the purpose of promoting clinical studies and basic research as they apply to groin hernias and the abdominal wall . Since that time, a true revolution in the field of hernia studies has transformed the field from a ”simple” disease to one that is very specialized. While the majority of surgeries for primary inguinal and abdominal wall hernia are performed in hospitals worldwide, complex situations such as multi recurrences, complications, abdominal wall reconstructions and others are being studied and treated in specialist centers. As a result, major institutions and societies are creating specific parameters and criteria to better address the complexities of hernia surgery. Hernia is a journal written by surgeons who have made abdominal wall surgery their specific field of interest, but we will consider publishing content from any surgeon who wishes to improve the science of this field. The Journal aims to ensure that hernia surgery is safer and easier for surgeons as well as patients, and provides a forum to all surgeons in the exchange of new ideas, results, and important research that is the basis of professional activity.