• Rebeccah B Baucom, William C Beck, Michael D Holzman, Kenneth W Sharp, William H Nealon, and Benjamin K Poulose.
• Vanderbilt University Medical Center, Nashville, TN. Electronic address: rebeccah.baucom@vanderbilt.edu.
• J. Am. Coll. Surg. 2014 Mar 1; 218 (3): 363-6.

BackgroundSurgeon physical examination is often used to monitor for hernia recurrence in clinical and research settings, despite a lack of information on its effectiveness. This study aims to compare surgeon-reviewed CT with surgeon physical examination for the detection of incisional hernia.Study DesignGeneral surgery patients with an earlier abdominal operation and a recent viewable CT scan of the abdomen and pelvis were enrolled prospectively. Patients with a stoma, fistula, or soft-tissue infection were excluded. Surgeon-reviewed CT was treated as the gold standard. Patients were stratified by body mass index into nonobese (body mass index <30) and obese groups. Testing characteristics and real-world performance, including positive predictive value and negative predictive value, were calculated.ResultsOne hundred and eighty-one patients (mean age 54 years, 68% female) were enrolled. Hernia prevalence was 55%. Mean area of hernias was 44.6 cm(2). Surgeon physical examination had a low sensitivity (77%) and negative predictive value (77%). This difference was more pronounced in obese patients, with sensitivity of 73% and negative predictive value 69%.ConclusionsSurgeon physical examination is inferior to CT for detection of incisional hernia, and fails to detect approximately 23% of hernias. In obese patients, 31% of hernias are missed by surgeon physical examination. This has important implications for clinical follow-up and design of studies evaluating hernia recurrence, as ascertainment of this result must be reliable and accurate.Copyright © 2014 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

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