Skip to main content
Top
Published in: BMC Surgery 1/2016

Open Access 01-12-2016 | Research article

Giant ventral hernia—relationship between abdominal wall muscle strength and hernia area

Authors: K. Strigård, L. Clay, B. Stark, U. Gunnarsson, P. Falk

Published in: BMC Surgery | Issue 1/2016

Login to get access

Abstract

Background

Symptoms arising from giant ventral hernia have been considered to be related to weakening of the abdominal muscles. The aim of this study was to investigate the relationship between the area of the abdominal wall defect and abdominal wall muscle strength measured by the validated BioDex system together with a back/abdominal unit.

Methods

Fifty-two patients with giant ventral hernia (>10 cm wide) underwent CT scan, clinical measurement of hernia size and BioDex measurement of muscle strength prior to surgery. The areas of the hernia derived from CT scan and from clinical measurement were compared with BioDex forces in the modalities extension, flexion and isometric contraction. The Spearman rank test was used to calculate correlations between area, BMI, gender, age, and muscle strength.

Result

The hernia area calculated from clinical measurements correlated to abdominal muscle strength measured with the Biodex for all modalities (p-values 0.015–0.036), whereas no correlation was seen with the area calculated by CT scan. No relationship was seen between BMI, gender, age and the area of the hernia.

Discussion

The inverse correlation between BioDex abdominal muscle strength and clinically assessed hernia area, seen in all modalities, was so robust that it seems safe to conclude that the area of the hernia is an important determinant of the degree of loss of abdominal muscle strength. Results using hernia area calculated from the CT scan showed no such correlation and this would seem to concur with the results from a previous study by our group on patients with abdominal rectus diastasis. In that study, defect size assessed clinically, but not that measured by CT scan, was in agreement with the size of the diastasis measured intra-operatively.
The point at which the area of a hernia begins to correlate with loss of abdominal wall muscle strength remains unknown since this study only included giant ventral hernias.
Literature
1.
go back to reference Luijendijk RW, Lemmen MH, Hop WC, Wereldsma JC. Incisional hernia recurrence following “vest-over-pants” or vertical Mayo repair of primary hernias of the midline. World J Surg. 1997;21(1):62–5. Discussion 66.CrossRefPubMed Luijendijk RW, Lemmen MH, Hop WC, Wereldsma JC. Incisional hernia recurrence following “vest-over-pants” or vertical Mayo repair of primary hernias of the midline. World J Surg. 1997;21(1):62–5. Discussion 66.CrossRefPubMed
2.
go back to reference Goodenough CJ, Ko TC, Kao LS, Nguyen MT, Holihan JL, Alawadi Z, Nguyen DH, Flores JR, Arita NT, Roth JS, Liang MK. Development and validation of a risk stratification score for ventral incisional hernia after abdominal surgery: hernia expectation rates in intra-abdominal surgery (the HERNIA Project). J Am Coll Surg. 2015;220(4):405–13.CrossRefPubMedPubMedCentral Goodenough CJ, Ko TC, Kao LS, Nguyen MT, Holihan JL, Alawadi Z, Nguyen DH, Flores JR, Arita NT, Roth JS, Liang MK. Development and validation of a risk stratification score for ventral incisional hernia after abdominal surgery: hernia expectation rates in intra-abdominal surgery (the HERNIA Project). J Am Coll Surg. 2015;220(4):405–13.CrossRefPubMedPubMedCentral
3.
go back to reference Klinge U, Si ZY, Zheng H, Schumpelick V, Bhardwaj RS, Klosterhalfen B. Collagen I/III and matrix metalloproteinases (MMP) 1 and 13 in the fascia of patients with incisional hernias. J Invest Surg. 2001;14(1):47-54. Klinge U, Si ZY, Zheng H, Schumpelick V, Bhardwaj RS, Klosterhalfen B. Collagen I/III and matrix metalloproteinases (MMP) 1 and 13 in the fascia of patients with incisional hernias. J Invest Surg. 2001;14(1):47-54.
4.
go back to reference Mingoli A, Puggioni A, Sgarzini G, Luciani G, Corzani F, Ciccarone F, Baldassarre E, Modini C. Incidence of incisional hernia following emergency abdominal surgery. Ital J Gastroenterol Hepatol. 1999;31(6):449–53.PubMed Mingoli A, Puggioni A, Sgarzini G, Luciani G, Corzani F, Ciccarone F, Baldassarre E, Modini C. Incidence of incisional hernia following emergency abdominal surgery. Ital J Gastroenterol Hepatol. 1999;31(6):449–53.PubMed
5.
go back to reference Chung L, O’Dwyer PJ. Pain and its effects on physical activity and quality of life before operation in patients undergoing elective inguinal and ventral hernia repair. Am J Surg. 2014;208(3):406–411001. Jan-Feb;14(1):47-54.CrossRefPubMed Chung L, O’Dwyer PJ. Pain and its effects on physical activity and quality of life before operation in patients undergoing elective inguinal and ventral hernia repair. Am J Surg. 2014;208(3):406–411001. Jan-Feb;14(1):47-54.CrossRefPubMed
6.
go back to reference Thomsen CØ, Brøndum TL, Jørgensen LN. Quality of Life after Ventral Hernia Repair with Endoscopic Component Separation Technique. Scand J Surg. 2015 Feb 13. pii: 1457496915571402. Epub ahead of print Thomsen CØ, Brøndum TL, Jørgensen LN. Quality of Life after Ventral Hernia Repair with Endoscopic Component Separation Technique. Scand J Surg. 2015 Feb 13. pii: 1457496915571402. Epub ahead of print
8.
go back to reference Gunnarsson U, Johansson M, Strigård K. Assessment of abdominal muscle function using the Biodex System-4. Validity and reliability in healthy volunteers and patients with giant ventral hernia. Hernia. 2011;15(4):417–21.CrossRefPubMed Gunnarsson U, Johansson M, Strigård K. Assessment of abdominal muscle function using the Biodex System-4. Validity and reliability in healthy volunteers and patients with giant ventral hernia. Hernia. 2011;15(4):417–21.CrossRefPubMed
9.
go back to reference den Hartog D, Eker H, Tuinebreijer WE, Kleinrensin G, Stam H, Lange J. Isokinetic strength of the trunk flexor muscles after surgical repair for incisional hernia. Hernia. 2010;14(3):243–7.CrossRef den Hartog D, Eker H, Tuinebreijer WE, Kleinrensin G, Stam H, Lange J. Isokinetic strength of the trunk flexor muscles after surgical repair for incisional hernia. Hernia. 2010;14(3):243–7.CrossRef
10.
go back to reference Johansson M, Gunnarsson U, Strigård K. Different techniques for mesh application give the same abdominal muscle strength. Hernia. 2011;15(1):65–8.CrossRefPubMed Johansson M, Gunnarsson U, Strigård K. Different techniques for mesh application give the same abdominal muscle strength. Hernia. 2011;15(1):65–8.CrossRefPubMed
11.
go back to reference Stark B, Emanuelsson P, Gunnarsson U, Strigård K. Validation of Biodex system 4 for measuring the strength of muscles in patients with rectus diastasis. J Plast Surg Hand Surg. 2012;46(2):102–5.CrossRefPubMed Stark B, Emanuelsson P, Gunnarsson U, Strigård K. Validation of Biodex system 4 for measuring the strength of muscles in patients with rectus diastasis. J Plast Surg Hand Surg. 2012;46(2):102–5.CrossRefPubMed
12.
go back to reference Cyriac C, Sharma RK, Singh G. Assessment of the abdominal wall function after pedicled TRAM flap surgery for breast reconstruction: Use of modified mesh repair for the donor defect. Indian J Plast Surg. 2010;43(2):166–72.CrossRefPubMedPubMedCentral Cyriac C, Sharma RK, Singh G. Assessment of the abdominal wall function after pedicled TRAM flap surgery for breast reconstruction: Use of modified mesh repair for the donor defect. Indian J Plast Surg. 2010;43(2):166–72.CrossRefPubMedPubMedCentral
14.
go back to reference Krpata DM, Schmotzer BJ, Flocke S, Jin J, Blatnik JA, Ermlich B, Novitsky YW, Rosen MJ. Design and initial implementation of HerQLes: a hernia-related quality-of-life survey to assess abdominal wall function. J Am Coll Surg. 2012;215(5):635–42.CrossRefPubMed Krpata DM, Schmotzer BJ, Flocke S, Jin J, Blatnik JA, Ermlich B, Novitsky YW, Rosen MJ. Design and initial implementation of HerQLes: a hernia-related quality-of-life survey to assess abdominal wall function. J Am Coll Surg. 2012;215(5):635–42.CrossRefPubMed
15.
go back to reference Ross SW, Wormer BA, Kim M, Oommen B, Bradley JF, Lincourt AE, Augenstein VA, Heniford BT. Defining surgical outcomes and quality of life in massive ventral hernia repair: an international multicenter prospective study. Am J Surg. 2015;210(5):801–13.CrossRefPubMed Ross SW, Wormer BA, Kim M, Oommen B, Bradley JF, Lincourt AE, Augenstein VA, Heniford BT. Defining surgical outcomes and quality of life in massive ventral hernia repair: an international multicenter prospective study. Am J Surg. 2015;210(5):801–13.CrossRefPubMed
16.
go back to reference Clay L, Fränneby U, Sandblom G, Gunnarsson U, Strigård K. Validation of a questionnaire for the assessment of pain following ventral hernia repair--the VHPQ. Langenbecks Arch Surg. 2012;397(8):1219–24.CrossRefPubMed Clay L, Fränneby U, Sandblom G, Gunnarsson U, Strigård K. Validation of a questionnaire for the assessment of pain following ventral hernia repair--the VHPQ. Langenbecks Arch Surg. 2012;397(8):1219–24.CrossRefPubMed
17.
go back to reference Tsirline VB, Colavita PD, Belyansky I, Zemlyak AY, Lincourt AE, Heniford BT. Preoperative pain is the strongest predictor of postoperative pain and diminished quality of life after ventral hernia repair. Am Surg. 2013;79(8):829–36.PubMed Tsirline VB, Colavita PD, Belyansky I, Zemlyak AY, Lincourt AE, Heniford BT. Preoperative pain is the strongest predictor of postoperative pain and diminished quality of life after ventral hernia repair. Am Surg. 2013;79(8):829–36.PubMed
18.
go back to reference Winsnes A, Haapamäki MM, Gunnarsson U, Strigård K. Surgical outcome of mesh and suture repair in primary umbilical hernia: postoperative complications and recurrence. Hernia. 2016;15 (Epub ahead of print). Winsnes A, Haapamäki MM, Gunnarsson U, Strigård K. Surgical outcome of mesh and suture repair in primary umbilical hernia: postoperative complications and recurrence. Hernia. 2016;15 (Epub ahead of print).
19.
go back to reference Antoniou GA, Tentes IK, Antoniou SA, Simopoulos C, Lazarides MK. Matrix metalloproteinase imbalance in inguinal hernia formation. J Invest Surg. 2011;24(4):145–50.CrossRefPubMed Antoniou GA, Tentes IK, Antoniou SA, Simopoulos C, Lazarides MK. Matrix metalloproteinase imbalance in inguinal hernia formation. J Invest Surg. 2011;24(4):145–50.CrossRefPubMed
20.
go back to reference Emanuelsson P, Gunnarsson U, Strigård K, Stark B. Early complications, pain, and quality of life after reconstructive surgery for abdominal rectus muscle diastasis: a 3-month follow-up. J Plast Reconstr Aesthet Surg. 2014;67(8):1082–8.CrossRefPubMed Emanuelsson P, Gunnarsson U, Strigård K, Stark B. Early complications, pain, and quality of life after reconstructive surgery for abdominal rectus muscle diastasis: a 3-month follow-up. J Plast Reconstr Aesthet Surg. 2014;67(8):1082–8.CrossRefPubMed
21.
go back to reference Emanuelsson P, Dahlstrand U, Strömsten U, Gunnarsson U, Strigård K, Stark B. Analysis of the abdominal musculo-aponeurotic anatomy in rectus diastasis: comparison of CT scanning and preoperative clinical assessment with direct measurement intraoperatively. Hernia. 2014;18(4):465–71.CrossRefPubMed Emanuelsson P, Dahlstrand U, Strömsten U, Gunnarsson U, Strigård K, Stark B. Analysis of the abdominal musculo-aponeurotic anatomy in rectus diastasis: comparison of CT scanning and preoperative clinical assessment with direct measurement intraoperatively. Hernia. 2014;18(4):465–71.CrossRefPubMed
Metadata
Title
Giant ventral hernia—relationship between abdominal wall muscle strength and hernia area
Authors
K. Strigård
L. Clay
B. Stark
U. Gunnarsson
P. Falk
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Surgery / Issue 1/2016
Electronic ISSN: 1471-2482
DOI
https://doi.org/10.1186/s12893-016-0166-x

Other articles of this Issue 1/2016

BMC Surgery 1/2016 Go to the issue