Annals of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회지)

The Korean Association of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회)
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Incidence of incisional hernia following liver surgery for colorectal liver metastases. Does the laparoscopic approach reduce the risk? A comparative study

  • Ahmed Hassan (Department of General & HPB Surgery, East Lancashire Hospitals NHS Trust, Royal Blackburn Hospital) ;
  • Kalaiyarasi Arujunan (Department of General & HPB Surgery, East Lancashire Hospitals NHS Trust, Royal Blackburn Hospital) ;
  • Ali Mohamed (Department of General & HPB Surgery, East Lancashire Hospitals NHS Trust, Royal Blackburn Hospital) ;
  • Vickey Katheria (Department of General & HPB Surgery, East Lancashire Hospitals NHS Trust, Royal Blackburn Hospital) ;
  • Kevin Ashton (University Hospitals of Morecambe Bay NHS Foundation Trust, Royal Lancaster Infirmary) ;
  • Rami Ahmed (Department of General & HPB Surgery, East Lancashire Hospitals NHS Trust, Royal Blackburn Hospital) ;
  • Daren Subar (Department of General & HPB Surgery, East Lancashire Hospitals NHS Trust, Royal Blackburn Hospital)
  • Received : 2023.11.02
  • Accepted : 2024.01.24
  • Published : 2024.05.31
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Abstract

Backgrounds/Aims: No reports to compare incisional hernia (IH) incidence between laparoscopic and open colorectal liver metastases (CRLM) resections have previously been made. This is the first comparative study. Methods: Single-center retrospective review of patients who underwent CRLM surgery between January 2011 and December 2018. IH relating to liver surgery was confirmed by computed tomography. Patients were divided into laparoscopic liver resection (LLR) and open liver resection (OLR) groups. Data collection included age, sex, presence of diabetes mellitus, steroid intake, history of previous hernia or liver resection, subcutaneous and peri-renal fat thickness, preoperative creatinine and albumin, American Society of Anesthesiologists (ASA) score, major liver resection, surgical site infection, synchronous presentation, and preoperative chemotherapy. Results: Two hundred and forty-seven patients were included with a mean follow-up period of 41 ± 29 months (mean ± standard deviation). Eighty seven (35%) patients had LLR and 160 patients had OLR. No significant difference in the incidence of IH between LLR and OLR was found at 1 and 3 years, respectively ([10%, 19%] vs. [10%, 19%], p = 0.95). On multivariate analysis, previous hernia history (hazard ratio [HR], 2.22; 95% confidence interval [CI], 1.56-4.86) and subcutaneous fat thickness (HR, 2.22; 95% CI, 1.19-4.13) were independent risk factors. Length of hospital stay was shorter in LLR (6 ± 4 days vs. 10 ± 8 days, p < 0.001), in comparison to OLR. Conclusions: In CRLM, no difference in the incidence of IH between LLR and OLR was found. Previous hernia and subcutaneous fat thickness were risk factors. Further studies are needed to assess modifiable risk factors to develop IH in LLR.

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References

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