Visceral obesity is a significant risk factor for incisional hernia after laparoscopic colorectal surgery: A single-center review

Introduction: Although laparoscopic surgery uses relatively small incisions, incisional hernia after surgery is not uncommon. However, the incidence of incisional hernia and its risk factors are not well known. The purpose of our study was to investigate risk factors for incisional hernia after laparoscopic colorectal cancer surgery. Methods: The study group consisted of 212 patients who underwent laparoscopic colorectal cancer surgery at Hiroshima Prefectural Hospital between November 2008 and October 2013. Diagnosis of incisional hernia was performed by postoperative CT. The visceral fat area (VFA) and subcutaneous fat area at the level of the umbilicus were calculated using an image analysis system. For statistical analysis, Fisher's exact test or Student's t-test were used for univariate analysis, and logistic regression analysis was used for multivariate analysis. The cut-off value for risk factors was calculated from the receiver-operator curve. Results: Incisional hernia was observed in 18 patients (8.5%). On univariate analysis, female sex (P = 0.04), older age (P = 0.02), subcutaneous fat area (P < 0.01), VFA (P = 0.02), and BMI >25 kg/m(2)(P < 0.01) were significant risk factors for incisional hernia. The predictive cut-off values were as follows: age, 72 years; subcutaneous fat area, 110 cm(2); VFA, 110 cm(2); and albumin concentration, 3.9 g/dL. On multivariate analysis, a VFA >110 cm(2) (P < 0.01) and female sex (P = 0.01) were retained as independent risk factors for incisional hernia. Conclusion: After laparoscopic colorectal cancer surgery, a higher VFA and female sex are independent risk factors for incisional hernia.