Incisional hernia in hepatobiliary and pancreatic surgery: incidence and risk factors

PurposeThe occurrence of incisional hernia (IH) is one of the main complications after open abdominal surgery. However, its incidence in hepatobiliary and pancreatic surgery is not known. Studies on hepatectomy and necrotizing pancreatitis show that the incidence can reach up to 42%. This study aims at evaluating the incidence of IH and its risk factors.MethodsPatients submitted to open hepatobiliary and pancreatic surgery at our centre between 2010 and 2016 were selected. IH was defined as discontinuity in the abdominal fascia reported during physical examination or on computed tomography. Variables analysed range from individual characteristics and medical history to surgical and postoperative aspects.ResultsThe cumulative incidence of IH was 21.6% at 72months. In pancreatic surgery, this incidence was 11.6%, while hepatobiliary patients presented an incidence of 27.0%. Cox regression showed that height (p=0.028), subcutaneous fat (p=0.037), wound dehiscence (p=0.001) and superficial surgical site infection (p=0.001) correlate positively with IH in pancreatic surgery patients. BMI (p=0.037) and perirenal fat (p=0.043) associated independently with IH in hepatobiliary surgery.ConclusionsHeight, obesity and wound complications are risk factors for IH in patients submitted to pancreatic surgery, whereas obesity presents as risk factor in hepatobiliary surgery patients. The incidence of IH goes up to 12% in patients submitted to pancreatic surgery, while this risk is higher in the hepatobiliary group (27%). It is suggested the adoption of strategies in the clinical practice prevents this high incidence, namely in high-risk patients.