Incidence of incisional hernia after laparotomy

Abstract

Purpose: We aim to estimate the incidence of incisional hernia (IH) during the 5 years post-laparotomy and, secondarily, to study the risk factors for IH development. Methods: Observational retrospective study. Data were collected from the electronic medical records of São João Hospital and University Centre. Patients (age>18 years old) who had been submitted to a laparotomy for general surgery procedures, between June 2015 and May 2018, were included. Variables analyzed, through univariate and multivariate analysis, included patients' characteristics, surgical techniques employed and post-surgery complications. The statistical analysis was carried out with R studio and IBM SPSS version 29.0. Results: The cumulative incidence of IH was 22.7% at 5 years, among the 1134 participants analyzed. In the multivariate analysis, we found that higher BMI (OR 1.056; p=0.007), superficial (OR 3.001; p=0.024) and organ-space (OR 2.686; p=0.004) surgical site infection (SSI) and wound dehiscence (OR 4.787; p<0.001) were independently associated with IH development. In contrast, transverse incision (OR 0.189; p=0.007) and layered closure of the abdominal (OR 0.503; p<0.001) were associated with a lower risk for IH, compared with midline incision and mass closure, respectively. Conclusion: Elevated BMI, SSI and wound dehiscence seem to present as risk factors for IH, while the use of transverse incision and employing a layered closure of the abdominal wall are associated with a reduced IH occurrence. Efforts aimed at optimizing preoperative patients' characteristics, surgical technique and implementation of effective infection prevention measures can play a crucial role in mitigating the incidence of IH post-laparotomy.