J Gastric Cancer.  2018 Dec;18(4):392-399. 10.5230/jgc.2018.18.e39.

Risk Factors for the Development of Incisional Hernia in Mini-laparotomy Wounds Following Laparoscopic Distal Gastrectomy in Patients with Gastric Cancer

• Jang EJ
• Kim MC
• Nam SH

• KMID: 2429885
• DOI: http://doi.org/10.5230/jgc.2018.18.e39

Abstract

PURPOSE
To determine the incidence of incisional hernia (IH) in mini-laparotomy wounds and analyze the risk factors of IH following laparoscopic distal gastrectomy in patients with gastric cancer.
MATERIALS AND METHODS
A total of 565 patients who underwent laparoscopic distal gastrectomy for gastric cancer at Dong-A University Hospital, Busan, South Korea, between June 2010 and December 2015, were enrolled. IH was diagnosed through physical examination or computed tomography imaging. Incidence rate and risk factors of IH were evaluated through a long-term follow-up.
RESULTS
Of those enrolled, 16 patients (2.8%) developed IH. The median duration of follow-up was 58 months (range, 25-90 months). Of the 16 patients with IH, 15 (93.7%) were diagnosed within 12 months postoperatively. Multivariate analysis showed that female sex (odds ratio [OR], 3.869; 95% confidence interval [CI], 1.325-11.296), higher body mass index (BMI; OR, 1.229; 95% CI, 1.048-1.422), and presence of comorbidity (OR, 3.806; 95% CI, 1.212-11.948) were significant risk factors of IH. The vast majority of IH cases (15/16 patients, 93.7%) developed in the totally laparoscopic distal gastrectomy (TLDG) group. However, the type of surgery (i.e., TLDG or laparoscopy-assisted distal gastrectomy) did not significantly affect the development of IH (P=0.060).
CONCLUSIONS
A median follow-up of 58 months showed that the overall incidence of IH in mini-laparotomy wounds was 2.8%. Multivariate analysis showed that female sex, higher BMI, and presence of comorbidity were significant risk factors of IH. Thus, surgeons should monitor the closure of mini-laparotomy wounds in patients with risk factors of IH undergoing laparoscopic distal gastrectomy.

Keyword

Stomach neoplasms; Laparoscopy; Hernia

MeSH Terms

Body Mass Index
Busan
Comorbidity
Female
Follow-Up Studies
Gastrectomy*
Hernia
Humans
Incidence
Incisional Hernia*
Korea
Laparoscopy
Multivariate Analysis
Physical Examination
Risk Factors*
Stomach Neoplasms*
Surgeons
Wounds and Injuries*

Figure

• 

  Fig. 1 Locations of ports and mini-laparotomy wounds (right upper quadrant or upper midline) of laparoscopy-assisted distal gastrectomy.

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  Fig. 2 Locations of ports and mini-laparotomy wound (peri-umbilical) of totally laparoscopic distal gastrectomy.

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