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Sonographic Imaging and Anterior Abdominal Wall Hernias
Gallstone formation is a widespread disease in the gastrointestinal Statistical Analysis
system, and the following factors can increase its incidence rate: All statistical analyses were fulfilled using IBM SPSS Statistics
Increasing age, female gender, obesity, pregnancy, familial heredity software (version 24) (IBM SPSS Statistics, Armonk, United States).
and nutritional habits, Crohn, spherocytosis, sickle cell anemia, A p-value of less than 0.05 was regarded to be statistically significant.
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thalassemia, and patients experiencing gastric or ileal resections. A Chi-square test was used for categorical data to identify significant
Diagnostic sonography is the primary modality to detect gallstones. differences. The comparisons of the age difference between the
Pathophysiology of anterior abdominal wall hernias can be related hernia types were performed with the analysis of variance (ANOVA).
to two series of factors. The first is related to each problem that
elevates intra-abdominal pressure, including obesity, pregnancy,
ascites, bowel obstruction, and peritoneal dialysis. The second is results
associated with structural and functional weakness of muscles, Ninety patients admitted for anterior abdominal wall herniorrhaphy
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tendons, and fascia of the abdominal wall. Congenital or acquired from September 2017 to September 2018 were studied. The mean
impairment in the metabolism of the collagen production cycle (for average age of the population was 49.17 ± 12.17 years. The intra-
example, due to smoking or malnutrition) plays an essential role abdominal surgically treatable disease was reported in 37 patients,
in creating the disease. The deficiency in the collagen production and the report was normal in 53 patients. The characteristics of the
cycle causes two classes of disorders: Molecular-cellular and subjects in the hernia groups are shown in Table 1. The age means
extracellular matrix diseases. Extracellular matrix disease is the of participants between the hernia groups using one-way ANOVA
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primary pathophysiology of ventral hernias. Having common showed no statistical significance (p = 0.524), which was confirmed by
risk factors for anterior abdominal hernias and cholelithiasis (as the post hoc test (p >0.05). Concerning gender ratio in the population,
the most common synchronous surgically treatable disease) a majority of patients were women (82.2% women vs 17.8% men), and
and its synchronous existence probability if not considered, it hernia groups had significant difference regarding sex ratio (p = 0.019).
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would be harmful to patients and healthcare systems. Since the Sonographic reports of patients were interpreted as follows. In the
demonstration of the simultaneous existence of intra-abdominal umbilical hernia group, eight cases of cholelithiasis and six cases of
surgically treatable diseases has two main advantages for patients, an abdominal mass (including two cases of uterine myoma, two cases
first, the time to diagnose and evaluate the synchronous condition of ovarian cancer, a case of HCC, and a case of sigmoid cancer) were
and second, saving laparoscopy as a surgical option for the reported. In the epigastric hernia group, four cases of cholelithiasis
treatment of patients. This approach to anterior abdominal wall and three cases of an abdominal mass (including two cases of simple
hernias has a lot of financial benefits for healthcare systems. ovarian cysts and a gastric gastrointestinal stromal tumor) were
observed (Table 2). Two cases of cholelithiasis and six cases of an
MAterIAls And Methods abdominal mass (including two cases of the myomatous uterus, two
cases of large uterine myoma, and two cases of advanced uterine
Ninety patients referred to the general surgery clinic of Urmia Imam cancer) were reported in the ventral hernia group. All reports of the
Khomeini Hospital for anterior abdominal wall herniorrhaphy were Spigelian hernia group were normal. In other words, there were 14
studied from September 2017 to September 2018. Our inclusion cases from 58 umbilical hernia patients, 7 cases from 20 epigastric
criteria were the patients who had anterior abdominal hernias. hernia patients, and 8 cases from 10 ventral hernia patients, requiring
This trial, approved by the Medical Ethics Committee of the Urmia a single surgery for their concomitant hernia and intra-abdominal
University of Medical Sciences, Urmia, Iran, is in accordance with the disease. The study of the population using the Chi-square test to
Declaration of Helsinki (approval number: IR. UMSU. REC. 97.1857). determine the need for further surgery (normal sonographic report
Subjects meeting the inclusion criteria were recruited in this rate) showed a statistical difference between the hernia groups
study after obtaining their written consent. Exclusion criteria were (p = 0.001). In the umbilical hernia group, the need for further surgery
incarcerated, or strangulated hernias, pregnant women, patients is significantly lower than that in the other groups (p <0.001) (Table 2).
with a history of psychiatric drug consumption, and patients with
end-stage cardiopulmonary disease or chronic renal failure, and
none of the patients had a history of opium addiction. In this dIscussIon
step, all patients screened with the abdominopelvic sonographic Anterior abdominal wall hernias are congenital or acquired and are
examination. The patients were divided into four groups: Umbilical, divided into umbilical, epigastric, ventral (incisional), and Spigelian
epigastric, ventral, and Spigelian hernias; and two sub-types: hernias according to their anatomic region. An umbilical hernia is
Group 1 (with normal sonographic report) treated only with the most common type that is generally prevalent in premature
herniorrhaphy and group 2 (including cholelithiasis or any newborns, and familial heredity has a recognized role in the incidence
synchronous surgically treatable disease) who were subject to a of this disease. Umbilical hernias in adolescents are acquired and more
single surgery for treating both disorders. All patients were screened commonplace in women than in men (with a 3:1 ratio). Although our
with a complete abdominopelvic sonographic examination. study confirmed the higher incidence of umbilical hernia (64.4%) among

Table 1: Characteristics of the subjects in the hernia groups
Hernia groups (N) Age (Mean ± SD) p 1 Men N (%) Women N (%) p 2
Umbilical hernia group (n = 58) 11.36 ± 47.74 8 (13.79) 50 (86.2)
Epigastric hernia group (n = 20) 13.53 ± 51.80 0.524 8 (40) 12 (60) 0.019
Ventral hernia group (n = 10) 14.92 ± 51.60 2 (20) 8 (80)
Spigelian hernia group (n = 2) 3.53 ± 52.50 0 (0) 2 (100)
p , using one-way ANOVA test; p , using Chi-square test
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112 World Journal of Laparoscopic Surgery, Volume 14 Issue 2 (May–August 2021)