Incisional hernia formation and associated risk factors on a gynecologic oncology service: an exploratory analysis

The aim of this study is to identify the rate of incisional hernias and associated risk factors following a vertical midline laparotomy on a gynecologic oncology service.

This is a retrospective cohort study of patients that underwent a laparotomy through a vertical midline abdominal incision between September 1998 and November 2012. Hernias and various factors were identified including demographics, disease comorbidities, intraoperative variables, and suture technique. Assessment of association with hernia formation was performed using Cox regression and log-rank test.

Two hundred and fifty-two patients with follow-up of at least 30 days were identified. Mean age was 59 years (range 21–88 years) and mean BMI was 35.9 kg/m² (range 17.2–84.4 kg/m²). Sixteen (6.3 %) developed incisional hernias with a median follow-up of 1.7 years (range 1 month to 13 years). The estimate of the 5-year probability of being hernia-free is 86 % (95 % CI 76.5–91.9). Average age of patients who developed a hernia was 66.2 years while average age of those without hernia was 58 years (p < 0.05). There was a significant association of hypertension with incisional hernia occurrence (p = 0.0035, log-rank test). Cancer was present in 100 % of patients that developed hernias and 73 % (172/236) of those that were hernia-free (p = 0.0041, log-rank test). By univariate analysis the risk of developing an incisional hernia was higher, if the abdominal fascia was closed with loop sutures (HR 4.6, 95 % CI 1.49–13.94; p = 0.008). By multivariable analysis incisions closed with loop suture had more than a fivefold increased risk of developing a hernia (HR 5.2, 95 % CI 1.65–16.39; p = 0.005). Presence of both hypertension and utilization of loop sutures had the highest risk of incisional hernia development (HR 7.1, 95 % CI 2.28–22.4; p = 0.001).

Wound complications including incisional hernias contribute to morbidity in gynecologic oncology patients. Older age, hypertension, utilization of loop sutures, and cancer were found to be associated with hernia formation after laparotomy through a vertical midline abdominal incision. The use of loop sutures to close the abdominal fascia should be investigated further.