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Incidence of incisional hernia after laparoscopic liver resection

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Abstract

Background

Minimally invasive techniques have been broadly introduced to liver surgery during the last couple of years. In this study, we aimed to report the incidence and potential risk factors for incisional hernia (IH) as well as health-related quality of life (HRQoL) after laparoscopic liver resections (LLR).

Methods

All patients undergoing LLR between January 2014 and June 2017 were contacted for an outpatient hernia examination. In all eligible patients, photo documentation of the scar was performed and IH was evaluated by clinical examination and by ultrasound. Patients also completed a questionnaire to evaluate IH-specific symptoms and HRQoL. Obtained results were retrospectively analyzed with regard to patients’ characteristics, perioperative outcomes and applied minimally invasive techniques, such as multi-incision laparoscopic liver surgery or hand-assisted/single-incision laparoscopic surgery (HALS/SILS).

Results

Of 184 patients undergoing surgery, 161 (87.5%) met the inclusion criteria and 49 patients (26.6%) participated in this study. After a median time of 26 months (range 19–50 months) after surgery, we observed an overall incidence of IH of 12%. Five of 6 patients were overweight or obese (BMI ≥ 25) and 5 of 6 hernias were located at the umbilical site. Univariate analysis suggested the performance status at time of operation (ASA score ≥ 3; HR 5.616, 95% CI 1.012–31.157, p = 0.048) and the approach (HALS/SILS, HR 6.571, 95% CI 1.097–39.379, p = 0.039) as potential risk factors for IH. A higher frequency of hernia-related physical restrictions (HRR; p = 0.058) and a decreased physical functioning (p = 0.17) were noted in patients with IH; however, both being short of statistical significance.

Conclusion

Advantages of laparoscopic surgery with regard to low rates of IH can be translated to minimally invasive liver surgery. Even though there are low rates of IH, patients with poor performance status at the time of operation should be monitored closely. While patients’ characteristics are hard to influence, it might be worth focusing on surgical factors such as the approach and the closure of the umbilical site to further minimize the rate of IH.

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Author notes

  1. P. Fikatas and M. Schmelzle contributed equally and share senior authorship.

Authors and Affiliations

  1. Department of Surgery,, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Campus Charité Mitte | Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany

    S. Wabitsch, P. Schulz, F. Fröschle, A. Kästner, C. Benzing, P. K. Haber, J. Pratschke, P. Fikatas & M. Schmelzle

  2. Department of Radiology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany

    U. Fehrenbach & T. Denecke

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  1. S. Wabitsch
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Contributions

WS: conception and design, analysis and interpretation, writing of the manuscript, SP: data collection, critical revision of the manuscript, FF: data collection, critical revision of the manuscript, KA: data collection, statistical analysis, critical revision of the manuscript, FU: ultrasound, critical revision of the article, BC: analysis and interpretation, critical revision of the manuscript, HPK: analysis and interpretation, critical revision of the manuscript, DT: supervision of ultrasound, critical analysis of the article, PJ: conception and interpretation, critical revision of the article, FP: conception and design, clinical examination, critical revision of the article, hernia repair, SM: conception and design, analysis and interpretation, critical revision of the article.

Corresponding author

Correspondence to M. Schmelzle.

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Disclosures

Schmelzle M reports personal fees from Merck, personal fees from Bayer, personal fees and other from ERBE, other from Ethicon, other from Takeda, other from Olympus, other from Medtronic, other from Intuitive, outside the submitted work. Pratschke J reports personal fees from Verb Surgical, other from Medtronic, other from Intuitive, from Merck, outside the submitted work. The authors Wabitsch S, Schulz P, Fröschle F, Kästner A, Fehrenbach U, Benzing C, Haber PK, Denecke T Fikatas P have no conflict of interest or financial ties to disclose.

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Wabitsch, S., Schulz, P., Fröschle, F. et al. Incidence of incisional hernia after laparoscopic liver resection. Surg Endosc 35, 1108–1115 (2021). https://doi.org/10.1007/s00464-020-07475-x

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