Missing the Mark: Evaluating the Validity of the Ventral Hernia Screen in Detecting Recurrence

Area of Science:

• Surgical outcomes research
• Medical diagnostics and screening

Background:

• Hernia recurrence is a key indicator of ventral hernia repair (VHR) success.
• Current screening tools, like the Ventral Hernia Screening (VHS) questionnaire, lack thorough evaluation.
• The predictive accuracy of the VHS for identifying hernia recurrence needs critical assessment.

Purpose of the Study:

• To evaluate the predictive value of the Ventral Hernia Screening (VHS) questionnaire for detecting hernia recurrence after VHR.
• To assess the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the VHS tool.

Main Methods:

• Retrospective cohort study of adult patients undergoing primary VHR with poly-4-hydroxybutyrate mesh.
• Inclusion criteria: primary VHR, poly-4-hydroxybutyrate mesh, and at least one postoperative VHS completion.
• Diagnostic confirmation via CT scan or physical exam for positive VHS screens; calculation of sensitivity, specificity, PPV, and NPV.

Main Results:

• 68 patients completed 119 VHS questionnaires; median follow-up was 3.6 years.
• The VHS demonstrated low sensitivity (40.0%) and very low PPV (5.7%).
• Individual VHS items also showed limited screening effectiveness, with low PPVs and varying sensitivities and specificities.

Conclusions:

• The VHS questionnaire is an inadequate tool for predicting hernia recurrence due to its low PPV and sensitivity.
• Patients may remain unaware of long-term hernia recurrence.
• Development of more robust monitoring tools for VHR recurrence is essential.