Incidence and predictors of incisional hernia after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

Tuttle, Todd M.; Huang, Jing; Kizy, Scott; Altman, Ariella M.; Nalluri, Harika; Marmor, Schelomo; Gaertner, Wolfgang B.; Jensen, Eric H.; Hui, Jane Yuet Ching

doi:10.1080/02656736.2019.1641634

Cited by 7 publications

(15 citation statements)

References 22 publications

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“…Finally, whilst chemotherapy, which is common in HPB procedures such as hepatectomies for metastases and pancreatectomies for pancreatic cancer, was only identified as a significant risk factor by Nilsson et al [36], Arslan et al [35] also observed a non-significant trend between IH and postoperative chemotherapy. Wound healing impairment secondary to systemic or intraperitoneal chemotherapy have been reported as a risk factor for IH formation [44]; however, there was not a clear association seen in our review. More studies exclusively analysing the incidence of IH after liver resections for colorectal metastases should be designed to confirm the association of chemotherapy found by Nilsson et al [36].…”

Section: Discussioncontrasting

confidence: 83%

Prevention of Incisional Hernia after Open Hepato-Pancreato-Biliary Surgery: A Systematic Review

et al. 2021

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Introduction Most hepato-pancreato-biliary (HPB) procedures are still performed through open approach. Incisional hernia (IH) is one of the most common complications after open surgery. To date, published data on IH after HPB surgery are scarce, therefore the aim of this study was to assess the current evidence regarding incidence, risk factors, and prevention. Methods Medline/PubMed (1946-2020), EMBASE (1947-2020), and the Cochrane library (1995-2020)) were searched for studies on IH in open HPB surgery. Animal studies, editorials, letters, reviews, comments, short case series and liver transplant, laparoscopic or robotic procedures were excluded. The protocol was registered with PROSPERO (CRD42020163296). Results A total of 5 079 articles were retrieved. 8 studies were finally included for the analysis. The incidence of IH after HPB surgery ranges from 7.7% to 38.8%. The identified risk factors were body mass index, surgical site infection, ascites, Mercedes or reversed T incisions and previous IH. Prophylactic mesh might be safe and effective. Conclusions IH after open HPB surgery is still an important matter. Some of the risk factors are specific for the HPB operations and the incision type should be carefully considered. Randomised controlled trials are required to confirm the role of prophylactic mesh after HPB operations.

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Section: Discussioncontrasting

confidence: 83%

Prevention of Incisional Hernia after Open Hepato-Pancreato-Biliary Surgery: A Systematic Review

et al. 2021

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“…Nevertheless, previous reports on CRS-HIPEC showed no additional risk for IH after this procedure, with IH rates of less than 10% in most of them. [5][6][7][8] Based on our clinical experience, the rates of IH after CRS-HIPEC were much higher than previously reported. The aim of this study was to evaluate the rate of IH after CRS-HIPEC and its risk factors.…”

Section: Introductionmentioning

confidence: 50%

“…Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS‐HIPEC) is potentially prone to hernias because it is a Xiphoid to pubis incision performed on patients who have undergone previous abdominal surgeries with the addition of chemotherapy and its related adverse effects (2). Nevertheless, previous reports on CRS‐HIPEC showed no additional risk for IH after this procedure, with IH rates of less than 10% in most of them 5–8 …”

Section: Introductionmentioning

confidence: 83%

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Increased risk for incisional hernia following cytoreductive surgery with hyperthermic intraperitoneal chemotherapy

Ben‐Yaacov,

Laks,

Zoabi

et al. 2023

ANZ Journal of Surgery

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IntroductionThe incidence of incisional hernias (IH) after midline laparotomy varies from 11% to 20%. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS‐HIPEC) is potentially prone to hernias because a Xiphoid to pubis laparotomy incision performed on patients who have undergone previous abdominal surgeries with the addition of chemotherapy and its related adverse effects.MethodsWe performed a retrospective analysis on a prospectively maintained single institution database from March 2015 to July 2020. The inclusion criteria were patients who underwent CRS‐HIPEC and had at least 6 months postoperative follow‐up with post‐operative cross‐sectional imaging study.ResultsTwo hundred and one patients were included in the study. All patients underwent CRS‐HIPEC with resection of previous scar and umbilectomy. Fifty‐four patients were diagnosed with IH (26.9%). The major risk factors for IH in multivariate analysis were higher American society of Anesthesiologists score (ASA) (OR 3.9, P = 0.012), increasing age (OR 1.06, P = 0.004) and increasing BMI (OR 1.1, P = 0.006). Most of the hernia sites were median (n = 43, 79.6%). Eleven (20.4%) patients had lateral hernias due to stoma incisions or drain sites. Most of the median hernias were at the level of the resected umbilicus 58.9% (n = 23). Five (9.3%) of the patients with IH necessitated an urgent surgical repair.ConclusionWe have demonstrated that more than a quarter of the patients after CRS‐HIPEC suffer from IH and up to 10% of them may require surgical intervention. More research is needed to find the appropriate intraoperative interventions to minimize this sequela.

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“…In our study, BMI was not deemed an influencing factor of IH. However, many studies have shown that BMI, especially BMI > 30 (obesity), is a risk factor for IH [ 33 , 34 ]. Obesity is likely to increase intra-abdominal pressure by putting mechanical stress on the abdominal incision, thus predisposing the occurrence of a hernia.…”

Section: Discussionmentioning

confidence: 99%

Low CT attenuation and high fatty infiltration rate of psoas are risk factors for incisional hernias after appendicectomy: a cross-sectional single-center study from China

Sun

Yan

et al. 2021

BMC Musculoskelet Disord

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Background Decreased computed tomography (CT) attenuation of muscle is independently associated with muscle weakness. The CT attenuation of the abdominal wall muscles may correlate with that of the psoas in patients without ventral hernias. This means that the CT attenuation of the psoas may be related to the occurrence of incisional hernias (IH). CT-determined sarcopenia was deemed inefficient in predicting the development of IH, while limited attention has been paid to the association between muscle fatty infiltration and incidences of IH. In this study, we aim to investigate whether the psoas’ CT measurement parameters, including the average CT attenuation, fatty infiltration rate and psoas muscle index, are associated with IH. Methods In this study, adult patients who had undergone an appendicectomy in the past and had then, for any reason, been hospitalised in our hospital from January 2018 to December 2019 were enrolled. The patients were classified into an IH group and a non-IH group. Their psoas’ CT attenuation, fatty infiltration rate (FIR) and psoas muscle index (PMI) were measured or calculated. Sarcopenia was defined according to their PMI. Differences between the two groups’ indices were then compared. A logistic regression model was applied to assess the effects of psoas’ CT measurement parameters on the occurrence of IH. Results One hundred twenty patients were included in this study. The psoas’ CT attenuation (p = 0.031) and PMI (p = 0.042) in the IH group were significantly lower than those in the non-IH group, and FIR in the IH group was significantly higher than in the non-IH group (p < 0.001). The patients’ psoas’ CT attenuation, FIR, PMI, age, gender and whether they had a history of smoking, were all significant factors in the univariate logistic regression analysis. After adjusting for confounding factors, a multivariate logistic regression analysis demonstrated that the psoas’ CT attenuation was an independent protective factor (p = 0.042), and FIR was an independent risk factor (p = 0.018), while neither PMI (p = 0.118) nor sarcopenia (p = 0.663) showed a significant effect on the incidence of IH. Conclusions When an appendectomy has been performed, a decreased CT attenuation and increased FIR of the psoas can be considered risk factors for IH.

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Incidence and predictors of incisional hernia after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

Cited by 7 publications

References 22 publications

Prevention of Incisional Hernia after Open Hepato-Pancreato-Biliary Surgery: A Systematic Review

Prevention of Incisional Hernia after Open Hepato-Pancreato-Biliary Surgery: A Systematic Review

Increased risk for incisional hernia following cytoreductive surgery with hyperthermic intraperitoneal chemotherapy

Low CT attenuation and high fatty infiltration rate of psoas are risk factors for incisional hernias after appendicectomy: a cross-sectional single-center study from China

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