Skip to main content

Advertisement

SpringerLink
Log in

Incisional hernia in hepatobiliary and pancreatic surgery: incidence and risk factors

  • Original Article
  • Published:
Hernia Aims and scope Submit manuscript

Abstract

Purpose

The occurrence of incisional hernia (IH) is one of the main complications after open abdominal surgery. However, its incidence in hepatobiliary and pancreatic surgery is not known. Studies on hepatectomy and necrotizing pancreatitis show that the incidence can reach up to 42%. This study aims at evaluating the incidence of IH and its risk factors.

Methods

Patients submitted to open hepatobiliary and pancreatic surgery at our centre between 2010 and 2016 were selected. IH was defined as discontinuity in the abdominal fascia reported during physical examination or on computed tomography. Variables analysed range from individual characteristics and medical history to surgical and postoperative aspects.

Results

The cumulative incidence of IH was 21.6% at 72 months. In pancreatic surgery, this incidence was 11.6%, while hepatobiliary patients presented an incidence of 27.0%. Cox regression showed that height (p = 0.028), subcutaneous fat (p = 0.037), wound dehiscence (p = 0.001) and superficial surgical site infection (p = 0.001) correlate positively with IH in pancreatic surgery patients. BMI (p = 0.037) and perirenal fat (p = 0.043) associated independently with IH in hepatobiliary surgery.

Conclusions

Height, obesity and wound complications are risk factors for IH in patients submitted to pancreatic surgery, whereas obesity presents as risk factor in hepatobiliary surgery patients. The incidence of IH goes up to 12% in patients submitted to pancreatic surgery, while this risk is higher in the hepatobiliary group (27%). It is suggested the adoption of strategies in the clinical practice prevents this high incidence, namely in high-risk patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Nilsson JH, Strandberg Holka P, Sturesson C (2016) Incisional hernia after open resections for colorectal liver metastases—incidence and risk factors. HPB (Oxford) 18(5):436–441. https://doi.org/10.1016/j.hpb.2016.02.001

    Article  Google Scholar 

  2. Li T, Robertson-More C, Maclean AR, Dixon E, Navsaria P, Nicol AJ, Kirkpatrick AW, Ball CG (2015) Bowel obstructions and incisional hernias following trauma laparotomy and the nonoperative therapy of solid organ injuries: a retrospective population-based analysis. J Trauma Acute Care Surg 79(3):386–392. https://doi.org/10.1097/TA.0000000000000765

    Article  PubMed  Google Scholar 

  3. Veljkovic R, Protic M, Gluhovic A, Potic Z, Milosevic Z, Stojadinovic A (2010) Prospective clinical trial of factors predicting the early development of incisional hernia after midline laparotomy. J Am Coll Surg 210(2):210–219. https://doi.org/10.1016/j.jamcollsurg.2009.10.013

    Article  PubMed  Google Scholar 

  4. Yamada T, Okabayashi K, Hasegawa H, Tsuruta M, Abe Y, Ishida T, Matsui S, Kitagawa Y (2016) Age, preoperative subcutaneous fat area, and open laparotomy are risk factors for incisional hernia following colorectal cancer surgery. Ann Surg Oncol 23(Suppl 2):S236–S241. https://doi.org/10.1245/s10434-015-4462-y

    Article  PubMed  Google Scholar 

  5. Lam HD, Vanlander A, Berrevoet F (2016) A comparative outcome analysis of incisional hernia repair in patients who underwent liver transplantation vs. those that underwent hepatopancreaticobiliary surgery using the EHS guidelines as a means of comparison. Clin Transplant 30(3):226–232. https://doi.org/10.1111/ctr.12678

    Article  PubMed  Google Scholar 

  6. Porrett PM, Hsu J, Shaked A (2009) Late surgical complications following liver transplantation. Liver Transpl 15(Suppl 2):S12–S18. https://doi.org/10.1002/lt.21893

    Article  PubMed  Google Scholar 

  7. Toso C, Meeberg GA, Bigam DL, Oberholzer J, Shapiro AM, Gutfreund K, Ma MM, Mason AL, Wong WW, Bain VG, Kneteman NM (2007) De novo sirolimus-based immunosuppression after liver transplantation for hepatocellular carcinoma: long-term outcomes and side effects. Transplantation 83(9):1162–1168. https://doi.org/10.1097/01.tp.0000262607.95372.e0

    Article  PubMed  CAS  Google Scholar 

  8. D’Angelica M, Maddineni S, Fong Y, Martin RC, Cohen MS, Ben-Porat L, Gonen M, DeMatteo RP, Blumgart LH, Jarnagin WR (2006) Optimal abdominal incision for partial hepatectomy: increased late complications with Mercedes-type incisions compared to extended right subcostal incisions. World J Surg 30(3):410–418. https://doi.org/10.1007/s00268-005-0183-x

    Article  PubMed  Google Scholar 

  9. Togo S, Nagano Y, Masumoto C, Takakura H, Matsuo K, Takeda K, Tanaka K, Endo I, Shimada H (2008) Outcome of and risk factors for incisional hernia after partial hepatectomy. J Gastrointest Surg 12(6):1115–1120. https://doi.org/10.1007/s11605-008-0469-z

    Article  PubMed  Google Scholar 

  10. Al-Azzawi HH, Kuhlenschmidt H, Howard TJ, Bermes AM, Bishop SN, Nakeeb A, Selzer DJ, Lillemoe KD, Zyromski NJ (2010) The burden of incisional hernia in necrotizing pancreatitis: how can we improve? Am J Surg 199(3):310–314. https://doi.org/10.1016/j.amjsurg.2009.08.039 discussion 314.

    Article  PubMed  Google Scholar 

  11. Muysoms FE, Antoniou SA, Bury K, Campanelli G, Conze J, Cuccurullo D, de Beaux AC, Deerenberg EB, East B, Fortelny RH, Gillion JF, Henriksen NA, Israelsson L, Jairam A, Janes A, Jeekel J, Lopez-Cano M, Miserez M, Morales-Conde S, Sanders DL, Simons MP, Smietanski M, Venclauskas L, Berrevoet F, European Hernia S (2015) European Hernia Society guidelines on the closure of abdominal wall incisions. Hernia 19(1):1–24. https://doi.org/10.1007/s10029-014-1342-5

    Article  PubMed  CAS  Google Scholar 

  12. Itatsu K, Yokoyama Y, Sugawara G, Kubota H, Tojima Y, Kurumiya Y, Kono H, Yamamoto H, Ando M, Nagino M (2014) Incidence of and risk factors for incisional hernia after abdominal surgery. Br J Surg 101(11):1439–1447. https://doi.org/10.1002/bjs.9600

    Article  PubMed  CAS  Google Scholar 

  13. van Ramshorst GH, Eker HH, Hop WC, Jeekel J, Lange JF (2012) Impact of incisional hernia on health-related quality of life and body image: a prospective cohort study. Am J Surg 204(2):144–150. https://doi.org/10.1016/j.amjsurg.2012.01.012

    Article  PubMed  Google Scholar 

  14. Daabiss M (2011) American Society of Anaesthesiologists physical status classification. Indian J Anaesth 55(2):111–115. https://doi.org/10.4103/0019-5049.79879

    Article  PubMed  PubMed Central  Google Scholar 

  15. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213

    Article  PubMed  PubMed Central  Google Scholar 

  16. Favre G, Grangeon-Chapon C, Raffaelli C, Francois-Chalmin F, Iannelli A, Esnault V (2017) Perirenal fat thickness measured with computed tomography is a reliable estimate of perirenal fat mass. PLoS One 12(4):e0175561. https://doi.org/10.1371/journal.pone.0175561

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  17. D’Haese JG, Werner J (2016) Resectability of pancreatic cancer: new criteria. Radiologe 56(4):318–324. https://doi.org/10.1007/s00117-016-0092-z

    Article  PubMed  Google Scholar 

  18. Kayashima H, Maeda T, Harada N, Masuda T, Guntani A, Ito S, Matsuyama A, Hamatake M, Tsutsui S, Matsuda H, Ishida T (2015) Risk factors for incisional hernia after hepatic resection for hepatocellular carcinoma in patients with liver cirrhosis. Surgery 158(6):1669–1675. https://doi.org/10.1016/j.surg.2015.06.001

    Article  PubMed  Google Scholar 

  19. Walming S, Angenete E, Block M, Bock D, Gessler B, Haglind E (2017) Retrospective review of risk factors for surgical wound dehiscence and incisional hernia. BMC Surg 17(1):19. https://doi.org/10.1186/s12893-017-0207-0

    Article  PubMed  PubMed Central  Google Scholar 

  20. Ayvazoglu Soy EH, Kirnap M, Yildirim S, Moray G, Haberal M (2017) Incisional hernia after liver transplant. Exp Clin Transplant 15(Suppl 1):185–189. https://doi.org/10.6002/ect.mesot2016.P65

    Article  PubMed  Google Scholar 

  21. Le Huu Nho R, Mege D, Ouaissi M, Sielezneff I, Sastre B (2012) Incidence and prevention of ventral incisional hernia. J Visc Surg 149(5 Suppl):e3–e14. https://doi.org/10.1016/j.jviscsurg.2012.05.004

    Article  PubMed  Google Scholar 

  22. Michaud DS, Giovannucci E, Willett WC, Colditz GA, Stampfer MJ, Fuchs CS (2001) Physical activity, obesity, height, and the risk of pancreatic cancer. JAMA 286(8):921–929

    Article  PubMed  CAS  Google Scholar 

  23. De Pastena M, Paiella S, Marchegiani G, Malleo G, Ciprani D, Gasparini C, Secchettin E, Salvia R, Bassi C (2017) Postoperative infections represent a major determinant of outcome after pancreaticoduodenectomy: results from a high-volume center. Surgery 162(4):792–801. https://doi.org/10.1016/j.surg.2017.05.016

    Article  PubMed  Google Scholar 

  24. Deerenberg EB, Harlaar JJ, Steyerberg EW, Lont HE, van Doorn HC, Heisterkamp J, Wijnhoven BP, Schouten WR, Cense HA, Stockmann HB, Berends FJ, Dijkhuizen FPH, Dwarkasing RS, Jairam AP, van Ramshorst GH, Kleinrensink GJ, Jeekel J, Lange JF (2015) Small bites versus large bites for closure of abdominal midline incisions (STITCH): a double-blind, multicentre, randomised controlled trial. Lancet 386(10000):1254–1260. https://doi.org/10.1016/S0140-6736(15)60459-7

    Article  PubMed  Google Scholar 

  25. Hidalgo MP, Ferrero EH, Ortiz MA, Castillo JM, Hidalgo AG (2011) Incisional hernia in patients at risk: can it be prevented? Hernia 15(4):371–375. https://doi.org/10.1007/s10029-011-0794-0

    Article  PubMed  CAS  Google Scholar 

  26. Nachiappan S, Markar S, Karthikesalingam A, Ziprin P, Faiz O (2013) Prophylactic mesh placement in high-risk patients undergoing elective laparotomy: a systematic review. World J Surg 37(8):1861–1871. https://doi.org/10.1007/s00268-013-2046-1

    Article  PubMed  Google Scholar 

  27. Jairam AP, Timmermans L, Eker HH, Pierik R, van Klaveren D, Steyerberg EW, Timman R, van der Ham AC, Dawson I, Charbon JA, Schuhmacher C, Mihaljevic A, Izbicki JR, Fikatas P, Knebel P, Fortelny RH, Kleinrensink GJ, Lange JF, Jeekel HJ, Group PT (2017) Prevention of incisional hernia with prophylactic onlay and sublay mesh reinforcement versus primary suture only in midline laparotomies (PRIMA): 2-year follow-up of a multicentre, double-blind, randomised controlled trial. Lancet 390(10094):567–576. https://doi.org/10.1016/S0140-6736(17)31332-6

    Article  PubMed  Google Scholar 

  28. Cho H, Yoshikawa T, Oba MS, Hirabayashi N, Shirai J, Aoyama T, Hayashi T, Yamada T, Oba K, Morita S, Sakamoto J, Tsuburaya A (2014) Matched pair analysis to examine the effects of a planned preoperative exercise program in early gastric cancer patients with metabolic syndrome to reduce operative risk: the Adjuvant Exercise for General Elective Surgery (AEGES) study group. Ann Surg Oncol 21(6):2044–2050. https://doi.org/10.1245/s10434-013-3394-7

    Article  PubMed  Google Scholar 

  29. Huan L, Fei Q, Lin H, Wan L, Li Y (2017) Is peritoneal drainage essential after pancreatic surgery? A meta-analysis and systematic review. Medicine (Baltimore) 96(51):e9245. https://doi.org/10.1097/MD.0000000000009245

    Article  Google Scholar 

  30. Strugala V, Martin R (2017) Meta-analysis of comparative trials evaluating a prophylactic single-use negative pressure wound therapy system for the prevention of surgical site complications. Surg Infect (Larchmt) 18(7):810–819. https://doi.org/10.1089/sur.2017.156

    Article  Google Scholar 

Download references

Funding

This work received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Faculty of Medicine of University of Porto, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal

    J. Chen-Xu, R. Bessa-Melo, L. Graça & J. Costa-Maia

  2. Department of Surgery, São João Hospital Center, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal

    R. Bessa-Melo, L. Graça & J. Costa-Maia

Authors
  1. J. Chen-Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. Bessa-Melo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. L. Graça
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Costa-Maia
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. Chen-Xu.

Ethics declarations

Conflict of interest

The authors declare that there are no conflicts of interest.

Ethical approval

This study was approved by the Ethics Commission of the São João Hospital Center.

Human and animal rights

All procedures performed in this retrospective study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study, formal consent is not required.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chen-Xu, J., Bessa-Melo, R., Graça, L. et al. Incisional hernia in hepatobiliary and pancreatic surgery: incidence and risk factors. Hernia 23, 67–79 (2019). https://doi.org/10.1007/s10029-018-1847-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10029-018-1847-4

Keywords

Search

Navigation