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World Journal of Surgery

, Volume 42, Issue 4, pp 1192–1199 | Cite as

Incidence of Clinically Relevant Incisional Hernia After Colon Cancer Surgery and Its Risk Factors: A Nationwide Claims Study

  • Gi Hyeon Seo
  • Eun Kyung ChoeEmail author
  • Kyu Joo Park
  • Young Jun Chai
Original Scientific Report

Abstract

Background

As there is scant literature focusing on incisional hernia for which hospital care is sought, the aim of this study was to elucidate the incidence and risk factors of overt incisional hernia (OIH) after colon cancer surgery using nationwide claims data.

Methods

Claims data of colon cancer patients who underwent regional colectomy were obtained from the Health Insurance Review and Assessment Service database of South Korea. Data from 2010 to 2012 were collected to ensure adequate follow-up. OIH was considered to be present when either the diagnosis code for IH or the claim code for IH repair was entered after index colectomy for colon cancer.

Results

A total of 24,645 patients underwent regional colectomy for colon cancer during the study period. Of these, 376 (1.5%) patients had an OIH within 3 years after surgery, and 50.3% of OIHs developed within the first year after the index colectomy (883.7 cases/10,000 patient-years). The Cox proportional hazard model showed that age >65 years, female gender, open colectomy, and institution volume <100 colectomies per year were statistically significant risk factors for OIH. The 3-year cumulative OIH incidence rates according to age >65 years, female gender, open colectomy, and institution volume <100 colectomies per year were 2.1, 2.1, 2.0, and 2.1%, respectively.

Conclusions

Several risk factors for OIH and its incidence after regional colectomy for colon cancer were identified. These findings are helpful for classifying patients undergoing segmental colectomy who have increased the likelihood of developing IH and are informative for patients and medical providers performing the surgery.

Notes

Compliance with ethical statements

Conflict of interest

The authors have no conflict of interest to declare.

References

  1. 1.
    Höer J, Lawong G, Klinge U et al (2002) Factors influencing the development of incisional hernia. A retrospective study of 2,983 laparotomy patients over a period of 10 years. Chirurg 73:474–480CrossRefPubMedGoogle Scholar
  2. 2.
    Höer J, Stumpf M, Rosch R et al (2002) Prevention of incisional hernia. Chirurg 73:881–887CrossRefPubMedGoogle Scholar
  3. 3.
    Nieuwenhuizen J, Halm JA, Jeekel J et al (2007) Natural course of incisional hernia and indications for repair. Scand J Surg 96:293–296CrossRefPubMedGoogle Scholar
  4. 4.
    Claes K, Beckers R, Heindryckx E et al (2014) Retrospective observational study on the incidence of incisional hernias after colorectal carcinoma resection with follow-up CT scan. Hernia 18:797–802CrossRefPubMedGoogle Scholar
  5. 5.
    Aquina CT, Rickles AS, Probst CP et al (2015) Visceral obesity, not elevated BMI, is strongly associated with incisional hernia after colorectal surgery. Dis Colon Rectum 58:220–227CrossRefPubMedGoogle Scholar
  6. 6.
    Mishra A, Keeler BD, Maxwell-Armstrong C et al (2014) The influence of laparoscopy on incisional hernia rates: a retrospective analysis of 1057 colorectal cancer resections. Colorectal Dis 16:815–821CrossRefPubMedGoogle Scholar
  7. 7.
    van Ramshorst GH, Eker HH, Hop WC et al (2012) Impact of incisional hernia on health-related quality of life and body image: a prospective cohort study. Am J Surg 204:144–150CrossRefPubMedGoogle Scholar
  8. 8.
    Klaristenfeld DD, McLemore EC, Li BH et al (2015) Significant reduction in the incidence of small bowel obstruction and ventral hernia after laparoscopic compared to open segmental colorectal resection. Langenbecks Arch Surg 400:505–512CrossRefPubMedGoogle Scholar
  9. 9.
    Fischer JP, Basta MN, Mirzabeigi MN et al (2016) A risk model and cost analysis of incisional hernia after elective, abdominal surgery based upon 12,373 cases: the case for targeted prophylactic intervention. Ann Surg 263:1010–1017CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Ihedioha U, Mackay G, Leung E et al (2008) Laparoscopic colorectal resection does not reduce incisional hernia rates when compared with open colorectal resection. Surg Endosc 22:689–692CrossRefPubMedGoogle Scholar
  11. 11.
    den Hartog D, Dur AH, Kamphuis AG et al (2009) Comparison of ultrasonography with computed tomography in the diagnosis of incisional hernias. Hernia 13:45–48CrossRefGoogle Scholar
  12. 12.
    Mudge M, Hughes LE (1985) Incisional hernia: a 10 year prospective study of incidence and attitudes. Br J Surg 72:70–71CrossRefPubMedGoogle Scholar
  13. 13.
    Kim L, Kim JA, Kim S (2014) A guide for the utilization of health insurance review and assessment service national patient samples. Epidemiol Health 36:e2014008CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Seo GH, Chai YJ, Choi HJ et al (2016) Incidence of permanent hypocalcaemia after total thyroidectomy with or without central neck dissection for thyroid carcinoma: a nationwide claim study. Clin Endocrinol (Oxf) 85:483–487CrossRefGoogle Scholar
  15. 15.
    Braga M, Frasson M, Vignali A et al (2005) Laparoscopic vs. open colectomy in cancer patients: long-term complications, quality of life, and survival. Dis Colon Rectum 48:2217–2223CrossRefPubMedGoogle Scholar
  16. 16.
    Lee L, Mappin-Kasirer B, Liberman AS et al (2012) High incidence of symptomatic incisional hernia after midline extraction in laparoscopic colon resection. Surg Endosc 26:3180–3185CrossRefPubMedGoogle Scholar
  17. 17.
    Widmar M, Keskin M, Beltran P et al (2016) Incisional hernias after laparoscopic and robotic right colectomy. Hernia 20:723–728CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Nakayama M, Yoshimatsu K, Yokomizo H et al (2014) Incidence and risk factors for incisional hernia after open surgery for colorectal cancer. Hepatogastroenterol 61:1220–1223Google Scholar
  19. 19.
    Togo S, Nagano Y, Masumoto C et al (2008) Outcome of and risk factors for incisional hernia after partial hepatectomy. J Gastrointest Surg 12:1115–1120CrossRefPubMedGoogle Scholar
  20. 20.
    O’Dwyer PJ, Courtney CA (2003) Factors involved in abdominal wall closure and subsequent incisional hernia. Surgeon 1:17–22CrossRefPubMedGoogle Scholar
  21. 21.
    Bhangu A, Nepogodiev D, Futaba K et al (2012) Systematic review and meta-analysis of the incidence of incisional hernia at the site of stoma closure. World J Surg 36:973–983. doi: 10.1007/s00268-012-1474-7 CrossRefPubMedGoogle Scholar
  22. 22.
    Hodgson NC, Malthaner RA, Ostbye T (2000) The search for an ideal method of abdominal fascial closure: a meta-analysis. Ann Surg 231:436–442CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Naguib N, Rafique H, Dhruva Rao PK et al (2015) A review of the incidence of iatrogenic hernia in both laparoscopic and open colorectal surgery: using CT as the gold standard of detection, cohort study. Int J Surg 19:87–90CrossRefPubMedGoogle Scholar
  24. 24.
    Dietz UA, Winkler MS, Härtel RW et al (2014) Importance of recurrence rating, morphology, hernial gap size, and risk factors in ventral and incisional hernia classification. Hernia 18:19–30CrossRefPubMedGoogle Scholar
  25. 25.
    Yamada T, Okabayashi K, Hasegawa H et al (2016) Age, preoperative subcutaneous fat area, and open laparotomy are risk factors for incisional hernia following colorectal cancer surgery. Ann Surg Oncol 23:S236–S241CrossRefPubMedGoogle Scholar
  26. 26.
    Caglià P, Tracia A, Borzì L et al (2014) Incisional hernia in the elderly: risk factors and clinical considerations. Int J Surg 12:S164–S169CrossRefPubMedGoogle Scholar
  27. 27.
    Henriksen NA, Yadete DH, Sorensen LT et al (2011) Connective tissue alteration in abdominal wall hernia. Br J Surg 98:210–219CrossRefPubMedGoogle Scholar
  28. 28.
    Sugerman HJ, Kellum JM, Reines HD et al (1996) Greater risk of incisional hernia with morbidly obese than steroid-dependent patients and low recurrence with prefascial polypropylene mesh. Am J Surg 171:80–84CrossRefPubMedGoogle Scholar
  29. 29.
    Santora TA, Roslyn JJ (1993) Incisional hernia. Surg Clin North Am 73:557–570CrossRefPubMedGoogle Scholar
  30. 30.
    Song IH, Ha HK, Choi SG et al (2012) Analysis of risk factors for the development of incisional and parastomal hernias in patients after colorectal surgery. J Korean Soc Coloproctol 28:299–303CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Henriksen NA, Helgstrand F, Vogt KC et al (2013) Risk factors for incisional hernia repair after aortic reconstructive surgery in a nationwide study. J Vasc Surg 57:1524–1530CrossRefPubMedGoogle Scholar
  32. 32.
    Ellis H, Gajraj H, George CD (1983) Incisional hernias: when do they occur? Br J Surg 70:290–291CrossRefPubMedGoogle Scholar
  33. 33.
    Kumar JGS, Kumar KU, Mallikarjuna M et al (2016) Incisional hernia: incidence, clinical profile, risk factors and prevention. Int Surg J 3:1292–1295Google Scholar
  34. 34.
    Adell-Carceller R, Segarra-Soria MA, Pellicer-Castell V et al (2006) Incisional hernia in colorectal cancer surgery. Associated risk factors. Cir Esp 79:42–45. doi: 10.1016/S0009-739X(06)70812-0 CrossRefPubMedGoogle Scholar
  35. 35.
    Veljkovic R, Protic M, Gluhovic A et al (2010) Prospective clinical trial of factors predicting the early development of incisional hernia after midline laparotomy. J Am Coll Surg 210:210–219CrossRefPubMedGoogle Scholar
  36. 36.
    Halm JA, Lip H, Schmitz PI et al (2009) Incisional hernia after upper abdominal surgery: a randomised controlled trial of midline versus transverse incision. Hernia 13:275–280CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Pereira JA, Pera M, Grande L (2013) Incidence of incisional hernia after open and laparoscopic colorectal cancer resection. Cir Esp 91:44–49CrossRefPubMedGoogle Scholar
  38. 38.
    Andersen LP, Klein M, Gögenur I et al (2008) Incisional hernia after open versus laparoscopic sigmoid resection. Surg Endosc 22:2026–2029CrossRefPubMedGoogle Scholar
  39. 39.
    Laurent C, Leblanc F, Bretagnol F et al (2008) Long-term wound advantages of the laparoscopic approach in rectal cancer. Br J Surg 95:903–908CrossRefPubMedGoogle Scholar
  40. 40.
    Benlice C, Stocchi L, Costedio MM et al (2016) Impact of the specific extraction-site location on the risk of incisional hernia after laparoscopic colorectal resection. Dis Colon Rectum 59:743–750CrossRefPubMedGoogle Scholar
  41. 41.
    Ng WT (2007) A full review of port-closure techniques. Surg Endosc 21:1895–1897CrossRefPubMedGoogle Scholar
  42. 42.
    Williams GL, Beaton C, Codd R et al (2012) Avoiding extraction site herniation after laparoscopic right colectomy. Tech Coloproctol 16:385–388CrossRefPubMedGoogle Scholar
  43. 43.
    Murray BW, Cipher DJ, Pham T et al (2011) The impact of surgical site infection on the development of incisional hernia and small bowel obstruction in colorectal surgery. Am J Surg 202:558–560CrossRefPubMedGoogle Scholar
  44. 44.
    Bosanquet DC, Ansell J, Abdelrahman T et al (2015) Systematic review and meta-regression of factors affecting midline incisional hernia rates: analysis of 14,618 patients. PLoS ONE 10:e0138745CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2017

Authors and Affiliations

  • Gi Hyeon Seo
    • 1
  • Eun Kyung Choe
    • 2
    Email author
  • Kyu Joo Park
    • 3
  • Young Jun Chai
    • 4
  1. 1.Health Insurance Review and Assessment ServiceSeoulKorea
  2. 2.Department of SurgerySeoul National University Hospital Healthcare System Gangnam CenterSeoulSouth Korea
  3. 3.Department of SurgerySeoul National University Hospital and College of MedicineSeoulKorea
  4. 4.Department of SurgerySeoul National University Boramae Medical CenterSeoulKorea

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