Incidence of Incisional Hernia Repair After Laparoscopic Compared to Open Resection of Colonic Cancer: A Nationwide Analysis of 17,717 Patients

  • Kristian Kiim JensenEmail author
  • Andreas Nordholm-Carstensen
  • Peter-Martin Krarup
  • Lars Nannestad Jorgensen
Original Scientific Report



It remains unknown whether laparoscopic compared to open surgery translates into fewer incisional hernia repairs (IHR). The objectives of the current study were to compare the long-term incidence of IHR and the size of repaired hernias between patients subjected to laparoscopic or open resection of colonic cancer.


This was a nationwide cohort study comprised of patients undergoing resection for colonic cancer between January 2007 and March 2016 according to the Danish Colorectal Cancer Group database. Patients who subsequently underwent IHR were identified in the Danish Ventral Hernia Database, from which information about the priority of the hernia repair and the size of the fascial defect was retrieved.


The study included 17,717 patients, of whom 482 (2.7%) underwent subsequent IHR during a median follow-up of 4.7 (interquartile range 2.8–6.9) years. There was no significant difference in the 5-year cumulative incidence of hernia repair after laparoscopic compared to open colonic resection (3.9%, CI 3.3–4.4% vs 4.1%, CI 3.5–4.6%). After adjustment for confounders, laparoscopic approach was associated with an increased rate of emergency IHR (HR 2.37, 95% CI 1.03–5.46, P = 0.042) as opposed to elective IHR (HR 0.91, 95% CI 0.73–1.14, P = 0.442). Laparoscopic surgery was significantly associated with a decreased fascial defect area compared to open surgery (mean difference −16.0 cm2, 95% CI −29.4 to −2.5, P = 0.020).


There was no difference in the incidence of IHR after open compared to laparoscopic resection. Compared to the open approach, laparoscopic resection increased the rate of subsequent emergency IHR, suggesting that a more aggressive therapeutic approach may be warranted in this patient group upon diagnosis of an incisional hernia.




Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was not required for this study.


  1. 1.
    Cone MM, Herzig DO, Diggs BS et al (2011) Dramatic decreases in mortality from laparoscopic colon resections based on data from the Nationwide Inpatient Sample. Arch Surg 146:594. CrossRefPubMedGoogle Scholar
  2. 2.
    Schwenk W, Haase O, Neudecker JJ, Müller JM (2005) Short term benefits for laparoscopic colorectal resection. Cochrane Database Syst Rev. CrossRefPubMedGoogle Scholar
  3. 3.
    Bartels SAL, Vlug MS, Hollmann MW et al (2014) Small bowel obstruction, incisional hernia and survival after laparoscopic and open colonic resection (LAFA study). Br J Surg 101:1153–1159. CrossRefPubMedGoogle Scholar
  4. 4.
    Jensen KK, Krarup P-M, Scheike T et al (2016) Incisional hernias after open versus laparoscopic surgery for colonic cancer: a nationwide cohort study. Surg Endosc 30:4469–4479. CrossRefPubMedGoogle Scholar
  5. 5.
    Helgstrand F, Rosenberg J, Kehlet H, Bisgaard T (2013) Outcomes after emergency versus elective ventral hernia repair: a prospective nationwide study. World J Surg 37:2273–2279. CrossRefPubMedGoogle Scholar
  6. 6.
    Altom LK, Snyder CW, Gray SH et al (2011) Outcomes of emergent incisional hernia repair. Am Surg 77:971–976PubMedGoogle Scholar
  7. 7.
    Poruk KE, Farrow N, Azar F et al (2016) Effect of hernia size on operative repair and post-operative outcomes after open ventral hernia repair. Hernia 20:805–810. CrossRefPubMedGoogle Scholar
  8. 8.
    Fischer JP, Wes AM, Wink JD et al (2014) Analysis of perioperative factors associated with increased cost following abdominal wall reconstruction (AWR). Hernia 18:617–624. CrossRefPubMedGoogle Scholar
  9. 9.
    Ingeholm P, Gögenür I, Iversen L (2016) Danish colorectal cancer group database. Clin Epidemiol 8:465–468. CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Helgstrand F, Jorgensen LN (2016) The Danish Ventral Hernia Database—a valuable tool for quality assessment and research. Clin Epidemiol 8:719–723. CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Lynge E, Sandegaard JL, Rebolj M (2011) The Danish National Patient Register. Scand J Public Health 39:30–33. CrossRefPubMedGoogle Scholar
  12. 12.
    von Elm E, Altman DG, Egger M et al (2007) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med 147:573–577CrossRefGoogle Scholar
  13. 13.
    Schemper M, Smith TL (1996) A note on quantifying follow-up in studies of failure time. Control Clin Trials 17:343–346CrossRefGoogle Scholar
  14. 14.
    Gray RJ (1988) A class of K-sample tests for comparing the cumulative incidence of a competing risk. Ann Stat 16:1141–1154CrossRefGoogle Scholar
  15. 15.
    Gerds TA, Scheike TH, Andersen PK (2012) Absolute risk regression for competing risks: interpretation, link functions, and prediction. Stat Med 31:3921–3930. CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Taylor GW, Jayne DG, Brown SR et al (2009) Adhesions and incisional hernias following laparoscopic versus open surgery for colorectal cancer in the CLASICC trial. Br J Surg 97:70–78. CrossRefGoogle Scholar
  17. 17.
    Pecorelli N, Greco M, Amodeo S, Braga M (2017) Small bowel obstruction and incisional hernia after laparoscopic and open colorectal surgery: a meta-analysis of comparative trials. Surg Endosc 31:85–99. CrossRefPubMedGoogle Scholar
  18. 18.
    Jensen KK, Munim K, Kjaer M, Jorgensen LN (2017) Abdominal wall reconstruction for incisional hernia optimizes truncal function and quality of life. Ann Surg 265:1235–1240. CrossRefPubMedGoogle Scholar
  19. 19.
    Rogmark P, Petersson U, Bringman S et al (2016) Quality of life and surgical outcome 1 year after open and laparoscopic incisional hernia repair. Ann Surg 263:244–250. CrossRefPubMedGoogle Scholar
  20. 20.
    Krpata DM, Schmotzer BJ, Flocke S et al (2012) Design and initial implementation of HerQLes: a hernia-related quality-of-life survey to assess abdominal wall function. J Am Coll Surg 215:635–642. CrossRefPubMedGoogle Scholar
  21. 21.
    Jensen KK, Erichsen R, Krarup P-M (2017) The impact of incisional hernia on mortality after colonic cancer resection. Surg Endosc 31:2149–2154. CrossRefPubMedGoogle Scholar
  22. 22.
    Jensen KK, Backer V, Jorgensen LN (2017) Abdominal wall reconstruction for large incisional hernia restores expiratory lung function. Surgery 161:517–524. CrossRefPubMedGoogle Scholar
  23. 23.
    Andersen P, Erichsen R, Frøslev T et al (2017) Open versus laparoscopic rectal cancer resection and risk of subsequent incisional hernia repair and paracolostomy hernia repair: a nationwide population-based cohort study. Surg Endosc. CrossRefPubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2020

Authors and Affiliations

  1. 1.Digestive Disease Center, Bispebjerg HospitalUniversity of CopenhagenCopenhagen NVDenmark

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