title: Computed tomography findings associated with the risk for emergency ventral hernia repair.
abstract: BACKGROUND
  Conventional wisdom teaches that small hernia defects are more likely to incarcerate. We aim to identify radiographic features of ventral hernias associated with increased risk of bowel incarceration.
  
  
  METHODS
  We assessed all patients who underwent emergent ventral hernia repair for bowel complications from 2009 to 2015. Cases were matched 1:3 with elective controls. Computed tomography scans were reviewed to determine hernia characteristics. Univariate and multivariable analyses were performed to identify variables associated with emergent surgery.
  
  
  RESULTS
  The cohort consisted of 88 patients and 264 controls. On univariate analysis, older age, higher ASA score, elevated BMI, ascites, larger hernias, small angle, and taller hernias were associated with emergent surgery. On multivariable analysis, morbid obesity, ascites, smaller angle, and taller hernias were independently associated with emergent surgery.
  
  
  CONCLUSIONS
  The teaching that large defects do not incarcerate is inaccurate; bowel compromise occurs with ventral hernias of all sizes. Instead, taller height and smaller angle are associated with the need for emergent repair. Early elective repair should be considered for patients with hernia features concerning for increased risk of bowel compromise.
authors.affiliation: Department of Surgery, University of Texas Health Science Center, Houston, TX, USA. Electronic address: Krislynn.M.Mueck@uth.tmc.edu.
authors.forename: Krislynn M
authors.initials: KM
authors.lastname: Mueck
authors.affiliation: Department of Surgery, University of Texas Health Science Center, Houston, TX, USA.
authors.forename: Julie L
authors.initials: JL
authors.lastname: Holihan
authors.affiliation: Department of Surgery, University of Texas Health Science Center, Houston, TX, USA.
authors.forename: Jiandi
authors.initials: J
authors.lastname: Mo
authors.affiliation: Department of Surgery, University of Texas Health Science Center, Houston, TX, USA.
authors.forename: Juan R
authors.initials: JR
authors.lastname: Flores-Gonzales
authors.affiliation: Department of Surgery, University of Texas Health Science Center, Houston, TX, USA.
authors.forename: Tien C
authors.initials: TC
authors.lastname: Ko
authors.affiliation: Department of Surgery, University of Texas Health Science Center, Houston, TX, USA.
authors.forename: Lillian S
authors.initials: LS
authors.lastname: Kao
authors.affiliation: Department of Surgery, University of Texas Health Science Center, Houston, TX, USA.
authors.forename: Mike K
authors.initials: MK
authors.lastname: Liang
mesh_terms: D001201:Ascites / Q000150:complications; D016022:Case-Control Studies; D004630:Emergencies; D005260:Female; D006555:Hernia, Ventral / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009767:Obesity, Morbid / Q000150:complications; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
keywords: CT scan; Emergent ventral hernia repair; Incisional hernia; Umbilical hernia; Ventral hernia