Skip to main content

Advertisement

SpringerLink
Log in

Visceral obesity is a predictor of surgical site occurrence and hernia recurrence after open abdominal wall reconstruction

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

Abstract

Purpose

High body mass index (BMI) increases the risk of postoperative complications and hernia recurrence after abdominal wall reconstruction (AWR). However, BMI does not provide specific information on the mass and distribution of adipose tissue. We hypothesized that visceral fat volume (VFV) was a better predictor than BMI for recurrence after AWR.

Methods

We included all patients undergoing AWR at our institution from November 2010 to December 2016. Data were collected from a prospective database and all patients were summoned for follow-up. VFV was calculated from preoperative CT. The primary and secondary outcomes were hernia recurrence and 30-day postoperative surgical site occurrences (SSO), respectively.

Results

We included a total of 154 patients. At follow-up, 42 (27.3%) patients had developed recurrence. The recurrence rate was significantly higher in patients with a VFV higher than the mean compared to a VFV lower than the mean, P = 0.004. After multivariable Cox-regression, VFV remained significantly predictive of recurrence (HR 1.09 per 0.5 L increase of VFV, P = 0.018). In contrary, BMI was not associated with hernia recurrence. There was no significant difference in the rate of SSO between patients with a VFV above and below the mean. A multivariable logistic regression model showed that VFV was significantly associated with development of SSO (OR 1.12 per 0.5 L increase, P = 0.009).

Conclusion

VFV was significantly associated with recurrence and SSOs after AWR. This study suggests VFV as a risk assessment tool for patients undergoing AWR.

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. Jensen KK, Munim K, Kjaer M, Jorgensen LN (2017) Abdominal wall reconstruction for incisional hernia optimizes truncal function and quality of life: a prospective controlled study. Ann Surg 265(6):1235–1240

    Article  Google Scholar 

  2. Jensen KK, Backer V, Jorgensen LN (2017) Abdominal wall reconstruction for large incisional hernia restores expiratory lung function. Surgery 161(2):517–524

    Article  Google Scholar 

  3. Novitsky YW, Fayezizadeh M, Majumder A, Neupane R, Elliott HL, Orenstein SB (2016) Outcomes of posterior component separation with transversus abdominis muscle release and synthetic mesh sublay reinforcement. Ann Surg 264(2):226–232

    Article  Google Scholar 

  4. Lin HJ, Spoerke N, Deveney C, Martindale R (2009) Reconstruction of complex abdominal wall hernias using acellular human dermal matrix: a single institution experience. Am J Surg 197(5):599–603

    Article  Google Scholar 

  5. Flum DR, Horvath K, Koepsell T (2003) Have outcomes of incisional hernia repair improved with time? A population-based analysis. Ann Surg 237(1):129–135

    Article  Google Scholar 

  6. Cornette B, De Bacquer D, Berrevoet F (2018) Component separation technique for giant incisional hernia: a systematic review. Am J Surg 215(4):719–726

    Article  Google Scholar 

  7. Sauerland S, Korenkov M, Kleinen T, Arndt M, Paul A (2004) Obesity is a risk factor for recurrence after incisional hernia repair. Hernia 8(1):42–46

    Article  CAS  Google Scholar 

  8. Burger JW, Luijendijk RW, Hop WC, Halm JA, Verdaasdonk EG, Jeekel J (2004) Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann J Surg 240(4):578–583

    Article  Google Scholar 

  9. Kokotovic D, Bisgaard T, Helgstrand F (2016) Long-term recurrence and complications associated with elective incisional hernia repair. JAMA 316(15):1575–1582

    Article  Google Scholar 

  10. Juvany M, Hoyuela C, Carvajal F, Trias M, Martrat A, Ardid J (2018) Long-term follow-up (at 5 years) of midline incisional hernia repairs using a primary closure and prosthetic onlay technique: recurrence and quality of life. Hernia 22(2):319–324

    Article  CAS  Google Scholar 

  11. Yamamoto M, Takakura Y, Ikeda S, Itamoto T, Urushihara T, Egi H (2018) Visceral obesity is a significant risk factor for incisional hernia after laparoscopic colorectal surgery: a single-center review. Asian J Endosc Surg 11:373–377

    Article  Google Scholar 

  12. Aquina CT, Rickles AS, Probst CP, Kelly KN, Deeb AP, Monson JR et al (2015) Visceral obesity, not elevated BMI, is strongly associated with incisional hernia after colorectal surgery. Dis Colon Rectum 58(2):220–227

    Article  Google Scholar 

  13. Winters H, Knaapen L, Buyne OR, Hummelink S, Ulrich DJO, van Goor H et al (2019) Pre-operative CT scan measurements for predicting complications in patients undergoing complex ventral hernia repair using the component separation technique. Hernia 23(2):347–354

    Article  CAS  Google Scholar 

  14. Jensen KK, Dressler J, Baastrup NN, Kehlet H, Jorgensen LN (2018) Enhanced recovery after abdominal wall reconstruction reduces length of postoperative stay: an observational cohort study. Surgery 165:393–397

    Article  Google Scholar 

  15. Jensen KK, Brondum TL, Harling H, Kehlet H, Jorgensen LN (2016) Enhanced recovery after giant ventral hernia repair. Hernia 20(2):249–256

    Article  CAS  Google Scholar 

  16. von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP et al (2014) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Int J Surg 12(12):1495–1499

    Article  Google Scholar 

  17. Nemoto M, Yeernuer T, Masutani Y, Nomura Y, Hanaoka S, Miki S et al (2014) Development of automatic visceral fat volume calculation software for CT volume data. J Obes 2014:495084

    Article  Google Scholar 

  18. Garner JS (1986) CDC guideline for prevention of surgical wound infections, 1985. Supersedes guideline for prevention of surgical wound infections published in 1982. Infect Control 7(3):193–200 ((Originally published in November 1985). Revised)

    Article  CAS  Google Scholar 

  19. Liang MK, Holihan JL, Itani K, Alawadi ZM, Gonzalez JR, Askenasy EP et al (2017) Ventral hernia management: expert consensus guided by systematic review. Ann Surg 265(1):80–89

    Article  Google Scholar 

  20. Liang MK, Li LT, Avellaneda A, Moffett JM, Hicks SC, Awad SS (2013) Outcomes and predictors of incisional surgical site infection in stoma reversal. JAMA Surg 148(2):183–189

    Article  Google Scholar 

  21. Cai X, Shen W, Guo Z, Li Y, Cao L, Gong J et al (2018) Thickness of subcutaneous fat is a predictive factor of incisional surgical site infection in crohn’s disease surgery: a retrospective study. Gastroenterol Res Pract 2018:1546075

    PubMed  PubMed Central  Google Scholar 

  22. Schlosser KA, Maloney SR, Gbozah K, Prasad T, Colavita PD, Augenstein VA et al (2020) The impact of weight change on intra-abdominal and hernia volumes. Surgery 167(5):876–882

    Article  Google Scholar 

  23. Shuster A, Patlas M, Pinthus JH, Mourtzakis M (2012) The clinical importance of visceral adiposity: a critical review of methods for visceral adipose tissue analysis. Br J Radiol 85(1009):1–10

    Article  CAS  Google Scholar 

  24. Imai Y, Lee SW, Kawai M, Tashiro K, Kawashima S, Tanaka R et al (2021) Visceral fat area is a better indicator of surgical outcomes after laparoscopic gastrectomy for cancer than the body mass index: a propensity score-matched analysis. Surg Endosc: Online ahead of print

  25. Okumura S, Kaido T, Hamaguchi Y, Kobayashi A, Shirai H, Yao S et al (2017) Visceral adiposity and sarcopenic visceral obesity are associated with poor prognosis after resection of pancreatic cancer. Ann Surg Oncol 24(12):3732–3740

    Article  Google Scholar 

  26. Park JW, Chang SY, Lim JS, Park SJ, Park JJ, Cheon JH et al (2021) Impact of visceral fat on survival and metastasis of stage III colorectal cancer. Gut Liver

  27. Verduin WM, Warps AK, van den Helder R, Doodeman HJ, Houdijk APJ, Fat IN et al (2021) Visceral fat and anastomotic leakage after colon cancer resection. Dis Colon Rectum 64(2):163–170

    Article  Google Scholar 

  28. Asaad M, Kapur SK, Baumann DP, Liu J, Butler CE (2020) Acellular dermal matrix provides durable long-term outcomes in abdominal wall reconstruction: a study of patients with over 60 months of follow-up. Ann Surg: Online ahead of print

  29. Henriksen NA, Friis-Andersen H, Jorgensen LN, Helgstrand F (2021) Open versus laparoscopic incisional hernia repair: nationwide database study. BJS Open 5(1):zraa010

    Article  Google Scholar 

Download references

Funding

No funding was received to perform this study.

Author information

Authors and Affiliations

  1. Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen NV, Denmark

    N. N. Baastrup, K. K. Jensen & L. N. Jorgensen

  2. Department of Radiology, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen NV, Denmark

    J. K. Christensen

Authors
  1. N. N. Baastrup
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. K. K. Jensen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. K. Christensen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. L. N. Jorgensen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to N. N. Baastrup.

Ethics declarations

Conflict of Interest

NN Baastrup, KK Jensen, JK Christensen, LN Jorgensen declare that they have no conflict of interest.

Ethics approval

All procedures performed in studies involving human participants 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. The study was approved by the Danish Data Protection Agency (j. no. 2012-58-0004). No animals were used to conduct this research.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Informed consent

The study was approved by the Danish Data Protection Agency (j. no. 2012-58-0004).

Human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any experiments on animals.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Baastrup, N.N., Jensen, K.K., Christensen, J.K. et al. Visceral obesity is a predictor of surgical site occurrence and hernia recurrence after open abdominal wall reconstruction. Hernia 26, 149–155 (2022). https://doi.org/10.1007/s10029-021-02522-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10029-021-02522-5

Keywords

Search

Navigation