Abstract
The complexity of abdominal defects necessitating operative repair has increased exponentially in recent years. In addition, there has been increasing adoption of advanced operative techniques, such as a variety of component separation techniques. Finally, there has been an explosion in the available prosthetic materials, both synthetic and biologic, to augment the repair. As a consequence of these factors, surgeons are currently taking on increasingly challenging abdominal wall defects than ever before. Careful preoperative imaging is crucial to every aspect of the management of these patients. Imaging aids in establishing the diagnosis, especially in patients with a large body habitus or in whom the presence of tenderness precludes an adequate clinical examination. Ultrasonography, in both the supine and standing positions and with and without the Valsalva maneuver, and computed tomography are most useful here. In the rare instance of concern for a hernia in the pregnant patient, magnetic resonance imaging might be required. Computed tomography is critical for operative planning. It can detect the presence of domain loss, necessitating a preoperative pneumoperitoneum. It also allows precise assessment of the size of the defect, relative size of the rectus abdominus muscle, and the size and state of the lateral abdominal wall musculature. This is a key step in determining the component separation technique that is ideal for the particular defect. Ultrasonography can be used intraoperatively to determine the location of the linea semilunaris for accurate placement of the initial incision in performing an endoscopic component separation. Ultrasonography and computed tomography are also critical in the detection of postoperative complications, including seromas, abscesses, and inflammatory reactions to the mesh used. Finally, ultrasonography and computed tomography are valuable in the detection of recurrence.