Intramuscular Adipose Tissue Content as a Predictor of Incisional Hernia after Hepatic Resection

Abstract

Background Incisional hernia (IH) is a common surgical complication, with an incidence of 6–31% following major abdominal surgery. This study aimed to investigate the impact of intramuscular adipose tissue content (IMAC) on the incidence of IH in patients who underwent hepatic resection. Methods Data of 205 patients who underwent open hepatic resection between 2007 and 2019 at Ehime University Hospital were retrospectively analyzed. Patient characteristics, perioperative findings, and body composition were compared between patients with IH and those without IH. The quantity and quality of skeletal muscle, calculated as skeletal muscle index and IMAC, were evaluated using preoperative computerized tomography images. Results Forty (19.5%) patients were diagnosed with IH. The cumulative incidence rates were 15.6% at 1 year and 19.6% at 3 years. On univariate analysis, body mass index, areas of subcutaneous and visceral fat, and IMAC were significantly higher in the IH group than in the non‐IH group (p = 0.0023, 0.0070, 0.0047, and 0.0080, respectively). No significant difference in skeletal muscle index was found between the groups (p = 0.3548). The incidence of diabetes mellitus, intraoperative transfusion, and postoperative wound infection was significantly higher in the IH group than in the non‐IH group (p = 0.0361, 0.0078, and 0.0299, respectively). On multivariate analysis, a high IMAC and wound infection were independent risk factors for IH (adjusted odds ratio, 2.83 and 4.52, respectively; p = 0.0152 and 0.0164, respectively). Conclusion IMAC can predict the incidence of IH in patients undergoing hepatic resection.

Impact of body fat location and volume on incisional hernia development and its outcomes following repair

“…The present study used VFA, SFA, and IMAC as variables to measure patients' obesity, and these variables successfully predicted the development of IH after surgery. In contrast, BMI was not a predictor of IH development in multivariate analysis 8,9,16–21 . The incidence of IH development varied from 1.0% to 27% in the included studies, 8,9,16–21 which may be due to differences in the type of abdominal surgery, primary disease, location of defects, and fascia closure techniques used.…”

“…One study, conducted on 205 patients who underwent open hepatic resection, reported the impact of IMAC on the incidence of IH 16 . The author found that a high IMAC was an independent risk factor for IH.…”

“…In contrast, BMI was not a predictor of IH development in multivariate analysis. 8,9,[16][17][18][19][20][21] The incidence of IH development varied from 1.0% to 27% in the included studies, 8,9,[16][17][18][19][20][21] which may be due to differences in the type of abdominal surgery, primary disease, location of defects, and fascia closure techniques used.…”

“…Impact of body fat location and volume on the development of incisional hernia after abdominal surgeries As shown in Table 1, eight studies 8,9,[16][17][18][19][20][21] reported the association between body fat volume and the development of IHs after abdominal surgeries. These studies used different body fat variables including intramuscular adipose tissue content (IMAC), SFA, VFA, VFV, total fat area (TFA), total fat volume (TFV), and perirenal fat, as summarized in Table 1.…”

“…Based on the eight studies reviewed, the majority (7 out of 8) did not find a significant independent association between BMI and the development of IH repair after abdominal surgeries. 8,9,[16][17][18]20,21 Only one study reported that BMI was associated independently with IH in hepatobiliary surgeries on multivariate analysis. 12 Part II As shown in Table 2, five studies were included.…”