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Observational Study
. 2021 Jul;35(7):3471-3478.
doi: 10.1007/s00464-020-07794-z. Epub 2020 Jul 14.

The risk factors for incisional hernia after laparoscopic colorectal surgery: a multicenter retrospective study at Yokohama Clinical Oncology Group

Hironori Fukuoka  1 , Jun Watanabe  2 , Oshi Masanori  3 , Yusuke Suwa  1 , Hirokazu Suwa  4 , Atsushi Ishibe  3 , Mitsuyoshi Ota  1 , Chikara Kunisaki  1 , Itaru Endo  3
Affiliations
Observational Study

The risk factors for incisional hernia after laparoscopic colorectal surgery: a multicenter retrospective study at Yokohama Clinical Oncology Group

Hironori Fukuoka et al. Surg Endosc. 2021 Jul.

Abstract

Background: Incisional hernia (IH) is a common complication after colorectal surgery. However, the risk factors for incisional hernia after laparoscopic colorectal surgery (LCRS) have not been fully elucidated. This retrospective study analyzed the incidence rate of IH and evaluated the risk factors for IH after LCRS.

Methods: This was a retrospective multi-institution study of 423 colorectal cancer patients conducted between September 2012 and December 2014 in Yokohama Clinical Oncology Group. The diagnosis of IH was based on computed tomography and physical examination findings. The patient-, tumor-, and surgery-related variables were examined by univariate and multivariate analyses.

Results: A total of 423 patients were analyzed. The median follow-up period was 48.4 months. IH was observed in 36 patients (8.5%). The 1-year incidence of IH was 5.2%, and the 4-year incidence was 8.5%. A multivariate analysis showed that preoperative umbilical hernia (odds ratio [OR] 5.71; 95% confidence interval [CI] 2.02-16.10; p = 0.001) and a visceral fat area (VFA) ≥ 100 cm2 (OR 2.74; 95% CI 1.08-6.96; p = 0.035) were independent risk factors of IH after LCRS.

Conclusions: The risk factors of IH after LCRS were preoperative umbilical hernia and VFA ≥ 100 cm2. In the case with an umbilical hernia or VFA ≥ 100 performing LCRS, it should likely NOT have a peri-umbilical extraction site and should be considered for an alternate site like a low transverse or Pfannenstiel incision.

Clinical trials registration: The trial was registered with the UMIN Clinical Trials Registry, number 000038707.

Keywords: Colorectal cancer; Incisional hernia; Laparoscopic surgery; Preoperative umbilical hernia; Visceral fat area.

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