Incisional Hernia Cannot Be Diagnosed by a Patient-Reported Diagnostic Questionnaire

Area of Science:

• Abdominal Surgery
• Hernia Research
• Diagnostic Tool Validation

Background:

• Incisional hernia (IH) is a common complication following abdominal surgery.
• Current diagnostic methods for IH, such as physical examination and imaging, are time-consuming, costly, and not always prioritized.
• A patient-reported diagnostic questionnaire was developed to address these challenges in IH follow-up.

Purpose of the Study:

• To validate a patient-reported diagnostic questionnaire for the detection of incisional hernias (IH).
• To assess the diagnostic accuracy of the questionnaire in a consecutive sample of post-abdominal surgery patients.

Main Methods:

• A prospective study included 241 patients over 18 years old who had undergone abdominal surgery with a midline incision at least 12 months prior.
• Patients completed the diagnostic questionnaire and underwent a physical examination.
• Diagnostic accuracy was evaluated using multivariable logistic regression, comparing questionnaire results to physical examination findings.

Main Results:

• Physical examination diagnosed incisional hernias (IH) in 54 (22%) of the 241 patients.
• The questionnaire demonstrated an area under the receiver operating characteristic curve of 0.82, with 81.5% sensitivity and 77.5% specificity.
• The questionnaire had a high negative predictive value (94%) but a lower positive predictive value (51.2%), missing 19% of IH cases.

Conclusions:

• The current patient-reported questionnaire is not sufficient for diagnosing incisional hernias (IH).
• Due to its high negative predictive value, the questionnaire may be useful in ruling out IH.
• Clinical examination remains the recommended method for long-term follow-up and diagnosis of incisional hernias.