Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 May;25(5):1297-1306.
doi: 10.1007/s11605-020-04762-9. Epub 2020 Aug 3.

Relationship Between Diverticular Disease and Incisional Hernia After Elective Colectomy: a Population-Based Study

Numa P Perez  1   2 , David C Chang  3 , Robert N Goldstone  4 , Liliana Bordeianou  4 , Rocco Ricciardi  4 , Paul M Cavallaro  4
Affiliations

Relationship Between Diverticular Disease and Incisional Hernia After Elective Colectomy: a Population-Based Study

Numa P Perez et al. J Gastrointest Surg. 2021 May.

Abstract

Background: Recent genetic studies identified common mutations between diverticular disease and connective tissue disorders, some of which are associated with abdominal wall hernias. Scarce data exists, however, shedding light on the potential clinical implications of this shared etiology, particularly in the era of laparoscopic surgery.

Methods: The New York Statewide Planning and Research Cooperative System database was used to identify adult patients undergoing elective sigmoid and left hemicolectomy (open or laparoscopic) from January 1, 2010, to December 31, 2016, for diverticulitis or descending/sigmoid colon cancer. The incidences of incisional hernia diagnosis and repair were compared using competing risks regression models, clustered by surgeon and adjusted for a host of demographic/clinical variables. Subsequent abdominal surgery and death were considered competing risks.

Results: Among 8279 patients included in the study cohort, 6811 (82.2%) underwent colectomy for diverticulitis and 1468 (17.8%) for colon cancer. The overall 5-year risk of incisional hernia was 3.5% among patients with colon cancer, regardless of colectomy route, which was significantly lower than that among diverticulitis patients after both open (10.7%; p < 0.001) and laparoscopic (7.2%; p = 0.007) colectomies. Multivariable analyses demonstrated that patients with diverticulitis experienced a two-fold increase in the risk for hernia diagnosis (aHR 1.8; p < 0.001) and repair (aHR 2.1; p < 0.001), and these findings persisted after stratification by colectomy route.

Conclusions: Patients undergoing elective colectomy for diverticulitis, including via laparoscopic approach, experience higher rates of incisional hernia compared with patients undergoing similar resections for colon cancer. When performing resections for diverticulitis, surgeons should strongly consider adherence to evidence-based guidelines for fascial closure to prevent this important complication.

Keywords: Colectomy; Connective tissue disorders; Incisional hernia.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest: Authors have no pertinent conflicts of interests to report.

Figures

Figure 1:
Figure 1:
Cohort Identification
Figure 2:
Figure 2:
Cumulative Incidence Function of Incisional Hernia Diagnosis (A, B, C) and Repair (D, E, F) – Univariate Competing-Risks Regression Model.
See this image and copyright information in PMC

References

    1. Maguire LH, Handelman SK, Du X, Chen Y, Pers TH, Speliotes EK. Genome-wide association analyses identify 39 new susceptibility loci for diverticular disease. Nat Genet. 2018;50(10):1359–65. - PMC - PubMed
    1. Schafmayer C, Harrison JW, Buch S, Lange C, Reichert MC, Hofer P, Cossais F, Kupcinskas J, von Schonfels W, Schniewind B, Kruis W, Tepel J, Zobel M, Rosendahl J, Jacobi T, Walther-Berends A, Schroeder M, Vogel I, Sergeev P, Boedeker H, Hinrichsen H, Volk A, Erk J, Burmeister G, Hendricks A, Hinz S, Wolff S, Bottner M, Wood AR, Tyrrell J, Beaumont RN, Langheinrich M, Kucharzik T, Brezina S, Huber-Schonauer U, Pietsch L, Noack LS, Brosch M, Herrmann A, Thangapandi RV, Schimming HW, Zeissig S, Palm S, Focke G, Andreasson A, Schmidt PT, Weitz J, Krawcsak M, Volzke H, Leeb G, Michl P, Lieb W, Grutzmann R, Franke A, Lammert F, Becker T, Kupcinskas L, D'Amato M, Wedel T, Datz C, Gsur A, Weedon MN, Hampe J. Genome-wide association analysis of diverticular disease points towards neuromuscular, connective tissue and epithelial pathomechanisms. Gut. 2019;68(5):854–65. - PubMed
    1. Peery AF, Crockett SD, Murphy CC, Lund JL, Dellon ES, Williams JL, Jensen ET, Shaheen NJ, Barritt AS, Lieber SR, Kochar B, Barnes EL, Fan YC, Pate V, Galanko J, Baron TH, Sandler RS. Burden and Cost of Gastrointestinal, Liver, and Pancreatic Diseases in the United States: Update 2018. Gastroenterology. 2019;156(1):254–72.e11. - PMC - PubMed
    1. Strassle PD, Kinlaw AC, Chaumont N, Angle HL, Lumpkin ST, Koruda MJ, Peery AF. Rates of Elective Colectomy for Diverticulitis Continued to Increase After 2006 Guideline Change. Gastroenterology. 2019;157(6):1679–81.e11. - PMC - PubMed
    1. Basta MN, Kozak GM, Broach RB, Messa CA, Rhemtulla I, DeMatteo RP, Serletti JM, Fischer JP. Can We Predict Incisional Hernia?: Development of a Surgery-specific Decision-Support Interface. Ann Surg. 2019;270(3):544–53. - PubMed

Publication types