DOI: 10.1093/bjs/znad258.471 ISSN:

313 Preoperative CT Imaging: A Tool to Predict Incisional Hernia Outcomes Following Abdominal Wall Reconstruction

M L Frommer, R Faderani, A Pérusseau-Lambert, M Kanapathy, A Malhotra, M Khosh Zaban, D Floyd, P E M Butler, S Ghali
  • Surgery



Abdominal wall reconstruction (AWR) is a surgical technique used to manage recurrent incisional hernias, which cause significant morbidity and are difficult to treat. In this study, we sought to determine whether subcutaneous abdominal fat thickness (AFT) measured at the xiphoid process, umbilicus, and pubic tubercle using preoperative CT scans could predict postoperative outcomes in patients undergoing AWR.


A retrospective cohort study was conducted on all patients who underwent AWR at our institution between 2009 and 2021 with a minimum follow-up of 12 months. Using preoperative CT scans, AFT was measured at the xiphoid process, umbilicus, and pubic tubercle, as well as the hernia dimensions. Demographic, operative, and surgical outcome data were also collected and analysed using statistical tests.


The results showed that 9 out of 101 patients (8.9%) experienced hernia recurrence. Smoking was significantly associated with an increased risk of hernia recurrence (p<0.001) and had a predictive odds ratio (OR) of 18.27 (p = 0.041). Increased AFT at the xiphoid (p = 0.005), umbilicus (p<0.001), and pubic tubercle (p<0.001) were also associated with hernia recurrence and additionally with risk of infection. However, only AFT at the pubic tubercle reached significance in the multivariate logistic regression model predicting recurrence (OR = 1.10; p = 0.030) and infection (OR = 1.04; p = 0.021).


In conclusion, smoking and increased subcutaneous abdominal fat thickness at the pubic tubercle are significant risk factors for recurrence and infection in patients undergoing abdominal wall reconstruction, and preoperative optimisation should focus on reducing these factors.

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