Top

Hernia

Published in:

01-08-2018 | Original Article

Surgery for diverticular disease results in a higher hernia rate compared to colorectal cancer: a population-based study from Ontario, Canada

Authors: E. S. Tang, D. I. Robertson, M. Whitehead, J. Xu, S. F. Hall

Published in: Hernia | Issue 4/2018

Abstract

Background

Incisional hernias are a well described complication of abdominal surgery. Previous studies identified malignancy and diverticular disease as risk factors. We compared incisional hernia rates between colon resection for colorectal cancer (CRC) and diverticular disease (DD).

Study design

We performed a retrospective, population-based, matched cohort study. Provincial databases were linked through the Institute for Clinical Evaluative Sciences. These databases include all patients registered under the universal Ontario Health Insurance Plan. Patients aged 18–105 undergoing open colon resection, without ostomy formation between April 1, 2002 and March 31, 2009, were included. We excluded those with previous surgery, hernia, obstruction, and perforation. The primary outcomes were surgery for hernia repair, or diagnosis of hernia in clinic.

Results

We identified 4660 cases of DD. These were matched 2:1 by age and gender to 8933 patients with CRC for a total of 13,593. At 5 years, incisional hernias occurred in 8.3% of patients in the CRC cohort, versus 13.1% of those undergoing surgery for DD. After adjusting for important confounders (comorbidity score, wound infection, age, diabetes, prednisone and chemotherapy), hernias were still more likely in patients with DD [HR 1.58, 95% Confidence Interval (CI) 1.43–1.76, P < 0.001]. The only significant covariate was wound infection (HR 1.63, 95% CI 1.43–1.87, P < 0.001).

Conclusion

Our study found that incisional hernias occur more commonly in patients with DD than CRC.

Yahchouchy-Chouillard E, Aura T, Picone O, Etienne JC, Fingerhut A (2003) Incisional hernias. I. Related risk factors. Dig Surg 20(1):3–9CrossRefPubMed

Mudge M, Hughes LE (1985) Incisional hernia: a 10 years prospective study of incidence and attitudes. Br J Surg 72(1):70–71CrossRefPubMed

Nguyen SQ, Divino CM, Buch KE et al (2008) Postoperative pain after laparoscopic ventral hernia repair: a prospective comparison of sutures versus tacks. JSLS 12(2):113–116PubMedPubMedCentral

van Ramshorst GH, Eker HH, Hop WC, Jeekel J, Lange JF (2012) Impact of incisional hernia on health-related quality of life and body image: a prospective cohort study. Am J Surg 204(2):144–150CrossRefPubMed

Altom LK, Snyder CW, Gray SH, Graham LA, Vick CC, Hawn MT (2011) Outcomes of emergent incisional hernia repair. Am Surg 77(8):971–976PubMed

Gomez R, Hidalgo M, Marques E et al (2001) Incidence and predisposing factors for incisional hernia in patients with liver transplantation. Hernia 5(4):172–176CrossRefPubMed

Bosanquet DC, Ansell J, Abdelrahman T et al (2015) Systematic review and meta-regression of factors affecting midline incisional hernia rates: analysis of 14,618 patients. PLoS One 10(9):e0138745CrossRefPubMedPubMedCentral

Schumpelick V, Fitzgibbons RJ (2007) Recurrent hernia prevention and treatment, 1st edn. Springer, BerlinCrossRef

Pollock AV, Evans M (1989) Early prediction of late incisional hernias. Br J Surg 76(9):953–954CrossRefPubMed

10.

Armstrong CP, Dixon JM, Duffy SW, Elton RA, Davies GC (1984) Wound healing in obstructive jaundice. Br J Surg 71(4):267–270CrossRefPubMed

11.

Pogacnik JS, Messaris E, Deiling SM et al (2014) Increased risk of incisional hernia after sigmoid colectomy for diverticulitis compared with colon cancer. J Am Coll Surg 218(5):920–928CrossRefPubMed

12.

Elixhauser A, Steiner C, Harris DR, Coffey RM (1998) Comorbidity measures for use with administrative data. Med Care 36(1):8–27CrossRefPubMed

13.

Andersen LP, Klein M, Gogenur I, Rosenberg J (2008) Incisional hernia after open versus laparoscopic sigmoid resection. Surg Endosc 22(9):2026–2029CrossRefPubMed

14.

Hidalgo MP, Ferrero EH, Ortiz MA, Castillo JM, Hidalgo AG (2011) Incisional hernia in patients at risk: can it be prevented? Hernia 15(4):371–375CrossRefPubMed

15.

Raffetto JD, Cheung Y, Fisher JB et al (2003) Incision and abdominal wall hernias in patients with aneurysm or occlusive aortic disease. J Vasc Surg 37(6):1150–1154CrossRefPubMed

16.

Liem MS, van der Graaf Y, Beemer FA, van Vroonhoven TJ (1997) Increased risk for inguinal hernia in patients with Ehlers–Danlos syndrome. Surgery 122(1):114–115CrossRefPubMed

17.

Pirson Y (2010) Extrarenal manifestations of autosomal dominant polycystic kidney disease. Adv Chronic Kidney Dis 17(2):173–180CrossRefPubMed

18.

Connelly TM, Tappouni R, Mathew P, Salgado J, Messaris E (2015) Risk factors for the development of an incisional hernia after sigmoid resection for diverticulitis: an analysis of 33 patients, operative and disease-associated factors. Am Surg 81(5):492–497PubMed

19.

Murray BW, Cipher DJ, Pham T, Anthony T (2011) The impact of surgical site infection on the development of incisional hernia and small bowel obstruction in colorectal surgery. Am J Surg 202(5):558–560CrossRefPubMed

20.

Deerenberg EB, Harlaar JJ, Steyerberg EW et al (2015) Small bites versus large bites for closure of abdominal midline incisions (STITCH): a double-blind, multicentre, randomised controlled trial. Lancet 386(10000):1254–1260CrossRefPubMed

21.

Cengiz Y, Blomquist P, Israelsson LA (2001) Small tissue bites and wound strength: an experimental study. Arch Surg 136(3):272–275CrossRefPubMed

22.

Ul Haque A, Moatasim A (2008) Adult polycystic kidney disease: a disorder of connective tissue? Int J Clin Exp Pathol 1(1):84–90PubMedPubMedCentral

23.

Scheff RT, Zuckerman G, Harter H, Delmez J, Koehler R (1980) Diverticular disease in patients with chronic renal failure due to polycystic kidney disease. Ann Intern Med 92(2 Pt 1):202–204CrossRefPubMed

24.

Del Peso G, Bajo MA, Costero O et al (2003) Risk factors for abdominal wall complications in peritoneal dialysis patients. Perit Dial Int 23(3):249–254PubMed

25.

Feingold D, Steele SR, Lee S et al (2014) Practice parameters for the treatment of sigmoid diverticulitis. Dis Colon Rectum 57(3):284–294CrossRefPubMed

26.

Garcia-Urena MA, Lopez-Monclus J, Hernando LA et al (2015) Randomized controlled trial of the use of a large-pore polypropylene mesh to prevent incisional hernia in colorectal surgery. Ann Surg 261(5):876–881CrossRefPubMed

27.

Muysoms FE, Antoniou SA, Bury K et al (2015) European Hernia Society guidelines on the closure of abdominal wall incisions. Hernia 19(1):1–24CrossRefPubMed

Title: Surgery for diverticular disease results in a higher hernia rate compared to colorectal cancer: a population-based study from Ontario, Canada
Authors: E. S. Tang
D. I. Robertson
M. Whitehead
J. Xu
S. F. Hall
Publication date: 01-08-2018
Publisher: Springer Paris
Published in: Hernia / Issue 4/2018
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI: https://doi.org/10.1007/s10029-017-1704-x

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Surgery for diverticular disease results in a higher hernia rate compared to colorectal cancer: a population-based study from Ontario, Canada

Abstract

Background

Study design

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Study design

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 4/2018

Reply to Comment to: A simplified surgical technique for recurrent inguinal hernia repair following total extraperitoneal patch plastic. Balta AZ, Senol Z, Sucullo I

Does the laparoscopic treatment of paediatric hydroceles represent a better alternative to the traditional open repair technique? A retrospective study of 1332 surgeries performed at two centres in China

Technical description of laparoscopic Morgagni hernia repair with primary closure and onlay composite mesh placement

Complications and recurrence rates of patients with Ehlers-Danlos syndrome undergoing ventral hernioplasty: a case series

Direct visualization transversus abdominis plane blocks offer superior pain control compared to ultrasound guided blocks following open posterior component separation hernia repairs

Trans-umbilical two-port laparoscopic suturing of the inguinal hernia defect with percutaneous assistance: a safe and efficient scarless surgery for pediatric inguinal hernia repair