Computed Tomography Verified Prevalence of Incisional Hernia 1 Year Postoperatively after Colorectal Cancer Resection

BACKGROUND AND OBJECTIVE: Incisional hernia is a frequent negative outcome after open and minimal invasive surgery of colorectal cancer. This study aimed to determine computed tomography-verified incisional hernia prevalence 1-year post colorectal cancer surgical resection in patients sutured with standardized small stich 4:1 technique, identify risk factors for incisional hernia and assess to what extent incisional hernia required surgical correction.METHODS: All patients subjected to resectional colorectal cancer surgery during 2012-2016 at Skåne University Hospital were identified in the Swedish Colorectal Cancer Registry. The 1-year follow-up computed tomography was re-evaluated to establish the presence of incisional hernia. Clinical data were collected from Swedish Colorectal Cancer Registry and the patients' medical charts were reviewed. Non-parametric tests and binary logistic regression analysis were used for statistical analysis.RESULTS: In total, 1744 tumors were identified resulting in 1231 patients meeting the inclusion criteria. In total, 25.9% (n = 319) had incisional hernia at the 1-year follow-up computed tomography and 13.2% (n = 162) of the colorectal cancer resections were minimal invasive surgery, and there was non-significant incisional hernia prevalence difference between open and minimal invasive surgery. However, for converted and non-converted minimal invasive surgery, the incisional hernia frequencies were 43.9% (n = 18) and 24.1% (n = 39), respectively (p = 0.012). Significant risk factors for incisional hernia were body mass index, wound rupture, and procedure time. During the follow-up time, 14.1% (n = 45) needed incisional hernia corrective surgery.CONCLUSIONS: Incisional hernia after colorectal cancer surgery is common despite standardized small stich 4:1 closure, but few incisional hernias are surgically corrected. Incisional hernia is equally frequent after open surgery and minimal invasive surgery. However, the risk of incisional hernia is considerably higher after minimal invasive surgery conversion