Umbilical fat is useful for evaluating the risk of incisional hernia after laparoscopic colorectal surgery.

PURPOSE: To investigate the risk factors for incisional hernia (IH) in colorectal cancer patients treated with laparoscopic surgery and midline laparotomy.

METHODS

We retrospectively reviewed 140 patients with colorectal cancer and examined their risk factors for IH. We analyzed the clinical findings and associations between these factors and the incidence of IH using Cox proportional hazards models. In particular, we considered umbilical fat.

RESULTS

The cumulative incidence of IH was 33.6% (47 patients), with three symptomatic patients (2.1%). In a multivariate proportional hazard analysis, umbilical fat (p < 0.01; hazard ratio, 6.56; 95% confidence interval, 2.73-15.70) and intermittent suturing with polyglycolic acid (p < 0.01; hazard ratio, 3.56; 95% confidence interval, 1.43-8.87) were significant risk factors for IH. Additionally, long operative times and adjuvant chemotherapy were associated with a high risk of IH in patients with running sutures for abdominal midline incisions.

CONCLUSION

Umbilical fat may be a significant risk factor for IH after laparoscopic colorectal surgery. Preoperative computed tomography is useful for assessing umbilical fat and identifying high-risk patients. Short-pitch running sutures performed for abdominal closure using a slowly absorbable monofilament suture material within a controlled operative time are essential for preventing IH.