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A postoperative body weight increase is a novel risk factor for incisional hernia of midline abdominal incision after elective gastroenterological surgery

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Abstract

Purpose

Midline abdominal incisions (MAIs) are widely used in both open and minimally invasive surgery. Incisional hernia (IH) accounts for most long-term postoperative wound complications. This study explored the risk factors for IH due to MAI in patients with clean-contaminated wounds after elective gastroenterological surgery.

Methods

The present study targeted patients enrolled in 2 randomized controlled trials to evaluate the efficacy of intraoperative interventions for incisional SSI prevention after gastroenterological surgery for clean-contaminated wounds. The patients were reassessed, and pre- and intraoperative variables and postoperative outcomes were collected. IH was defined as any abdominal wall gap, regardless of bulge, in the area of a postoperative scar that was perceptible or palpable on clinical examination or computed tomography according to the European Hernia Society guidelines. The risk factors for IH were identified using univariate and multivariate analyses.

Results

The study population included 1,281 patients, of whom 273 (21.3%) developed IH. Seventy-four (5.8%) patients developed incisional SSI. Multivariate logistic regression analysis revealed that female sex (odds ratio [OR], 1.39; 95% confidence interval [CI] 1.03–1.86, p = 0.031), high preoperative body mass index (OR, 1.81; 95% CI 1.19–2.77, p = 0.006), incisional SSI (OR, 2.29; 95% CI 1.34–3.93, p = 0.003), and postoperative body weight increase (OR, 1.49; 95% CI 1.09–2.04, p = 0.012) were independent risk factors for IH due to MAI in patients who underwent elective gastroenterological surgery.

Conclusion

We identified postoperative body weight increase at one year as a novel risk factor for IH in patients with MAI after elective gastroenterological surgery.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

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Funding

This study did not receive any specific grants from funding agencies in the public, commercial, or not-for-profit sector.

Author information

Authors and Affiliations

  1. Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan

    Yuki Mizusawa, Hiroshi Noda, Kosuke Ichida, Shota Fukai, Natsumi Matsuzawa, Sawako Tamaki, Iku Abe, Yuhei Endo, Taro Fukui, Yuji Takayama, Koetsu Inoue, Yuta Muto, Fumiaki Watanabe, Yasuyuki Miyakura & Toshiki Rikiyama

Authors
  1. Yuki Mizusawa
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  2. Hiroshi Noda
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  3. Kosuke Ichida
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Y.M., S.F., and K.I. The first draft of the manuscript was written by Y.M., HN, and K.I., and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Hiroshi Noda.

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Ethics approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Institutional Review Board of Saitama Medical Center, Jichi Medical University [S22-083].

Informed consent

The Institutional Review Board of Saitama Medical Center, Jichi Medical University, waived the need for informed consent because of the retrospective nature of the study.

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The authors declare no competing interests.

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Mizusawa, Y., Noda, H., Ichida, K. et al. A postoperative body weight increase is a novel risk factor for incisional hernia of midline abdominal incision after elective gastroenterological surgery. Langenbecks Arch Surg 408, 452 (2023). https://doi.org/10.1007/s00423-023-03193-9

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