Visceral obesity is a significant risk factor for incisional hernia after laparoscopic colorectal surgery: A single‐center review

• Published in: Asian journal of endoscopic surgery Vol. 11; no. 4; pp. 373 - 377
• Main Authors: Yamamoto, Masateru, Takakura, Yuji, Ikeda, Satoshi, Itamoto, Toshiyuki, Urushihara, Takashi, Egi, Hiroyuki
• Format: Journal Article
• Language: English
• Published: Kyoto, Japan John Wiley & Sons Australia, Ltd 01.11.2018; Wiley Subscription Services, Inc
• Subjects: Adult; Aged; Aged, 80 and over; Cancer surgery; Colectomy - methods; Colorectal cancer; Female; Follow-Up Studies; Hernias; Humans; Incisional hernia; Incisional Hernia - etiology; laparoscopic colorectal surgery; Laparoscopy; Logistic Models; Male; Middle Aged; Obesity, Abdominal - complications; Proctectomy - methods; Retrospective Studies; Risk Factors; Sex Factors; visceral fat area; visceral fat area; laparoscopic colorectal surgery; Incisional hernia
• ISSN: 1758-5902; 1758-5910
• DOI: 10.1111/ases.12466

Introduction Although laparoscopic surgery uses relatively small incisions, incisional hernia after surgery is not uncommon. However, the incidence of incisional hernia and its risk factors are not well known. The purpose of our study was to investigate risk factors for incisional hernia after laparoscopic colorectal cancer surgery. Methods The study group consisted of 212 patients who underwent laparoscopic colorectal cancer surgery at Hiroshima Prefectural Hospital between November 2008 and October 2013. Diagnosis of incisional hernia was performed by postoperative CT. The visceral fat area (VFA) and subcutaneous fat area at the level of the umbilicus were calculated using an image analysis system. For statistical analysis, Fisher's exact test or Student's t‐test were used for univariate analysis, and logistic regression analysis was used for multivariate analysis. The cut‐off value for risk factors was calculated from the receiver–operator curve. Results Incisional hernia was observed in 18 patients (8.5%). On univariate analysis, female sex (P = 0.04), older age (P = 0.02), subcutaneous fat area (P < 0.01), VFA (P = 0.02), and BMI >25 kg/m2 (P < 0.01) were significant risk factors for incisional hernia. The predictive cut‐off values were as follows: age, 72 years; subcutaneous fat area, 110 cm2; VFA, 110 cm2; and albumin concentration, 3.9 g/dL. On multivariate analysis, a VFA >110 cm2 (P < 0.01) and female sex (P = 0.01) were retained as independent risk factors for incisional hernia. Conclusion After laparoscopic colorectal cancer surgery, a higher VFA and female sex are independent risk factors for incisional hernia.