title: Increased risk of incisional hernia after sigmoid colectomy for diverticulitis compared with colon cancer.
abstract: BACKGROUND
  We aimed to determine if an increased incidence of incisional hernias is present in patients undergoing sigmoidectomy for diverticulitis vs cancer. The pathophysiology of diverticulitis is poorly understood, but might involve a collagen vascular abnormality that can predispose to incisional hernia.
  
  
  METHODS
  In this IRB-approved, retrospective study, patients who underwent sigmoid colectomies for diverticulitis or cancer between January 2003 and September 2012 were studied. Exclusion criteria included the development of surgical site infections and neoadjuvant chemoradiotherapy. A multivariate logistic regression was used with covariate adjustments for known risk factors for hernia development.
  
  
  RESULTS
  Four hundred forty-two patients (mean age 59.3 ± 13.9 years) with a median follow-up of 30 months were analyzed. The incidence of incisional hernia was 15.1% in diverticulitis patients vs 5.8% in the cancer cohort (41 of 271 vs 10 of 171; p = 0.003). Univariate analysis of risk factors associated with postoperative incisional hernia included steroid use (p = 0.007), wound packing (p = 0.001), higher American Society of Anesthesiologists classification (p = 0.001), absorbable suture closure (p = 0.02), blood transfusion (p = 0.04), stoma formation (p = 0.02), increased body mass index (p = 0.008), and history of incisional hernia (p = 0.00008). Multivariate logistic regression demonstrated a persistent association between diverticulitis and hernia development (p = 0.01). Odds of a hernia developing after sigmoidectomy for diverticulitis were 2.82 times greater than in the cancer cohort (95% CI, 1.3-6.6).
  
  
  CONCLUSIONS
  The incidence of an incisional hernia developing after a sigmoid colectomy is significantly higher when performed for diverticulitis as compared with cancer. This might be due to a connective tissue disorder, which predisposes to development of both diverticula and hernias.
authors.affiliation: Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA.
authors.forename: Javier S
authors.initials: JS
authors.lastname: Pogacnik
authors.affiliation: Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Messaris
authors.affiliation: Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Deiling
authors.affiliation: Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA.
authors.forename: Tara M
authors.initials: TM
authors.lastname: Connelly
authors.affiliation: Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, PA.
authors.forename: Arthur S
authors.initials: AS
authors.lastname: Berg
authors.affiliation: Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA.
authors.forename: David B
authors.initials: DB
authors.lastname: Stewart
authors.affiliation: Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA.
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: McKenna
authors.affiliation: Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA.
authors.forename: Lisa S
authors.initials: LS
authors.lastname: Poritz
authors.affiliation: Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA. Electronic address: wkoltun@hmc.psu.edu.
authors.forename: Walter A
authors.initials: WA
authors.lastname: Koltun
mesh_terms: D003082:Colectomy / Q000009:adverse effects* / Q000379:methods; D012809:Colon, Sigmoid / Q000601:surgery*; D003110:Colonic Neoplasms / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D046449:Hernia, Abdominal / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012810:Sigmoid Diseases / Q000601:surgery*; D014481:United States / Q000453:epidemiology