title: Incisional hernia after laparoscopic colorectal surgery. Is there any factor associated?
abstract: BACKGROUND
  Laparoscopic approach is related to, among others, educing abdominal wall complications such as incisional hernia (IH). However, there are scarce data concerning laparoscopic colorectal surgery (LCRS). The aim of this study was to evaluate related factors and incidence of IH following this approach.
  
  
  METHODS
  A retrospective analysis of consecutive patients who underwent colorectal surgery with laparoscopic approach in a single center was performed. Patients with a minimum follow-up of 6 months, and also converted to open surgery were included. Uni- and multi-variate analyses were performed using the following variables: age; gender; type of surgery (left, right, total, or segmental colectomy); comorbidities [diabetes and chronic pulmonary obstructive disease (COPD)]; previous surgery; colorectal disease (benign and malignant); operative time; surgical site infection (SSI); and body mass index (BMI). Midline incisions (right colectomy) and off-midline incisions (left colectomies and rectal resections) were also compared.
  
  
  RESULTS
  During a period of 12 years, 1051 laparoscopic colorectal surgeries were performed. The incidence of IH was 6% (n = 63). Univariate analysis showed that BMI > 30 kg/m(2) [p < 0.01, OR: 2.3 (1.3-4.7)], SSI [p < 0.01, OR: 6.5 (3.4-12.5)], operative time >180 min [p < 0.01, OR: 2.1 (1.2-3.6)] and conversion to open surgery (p = 0.01, OR: 2.4 [1.1-5.0]) were related to incisional hernias. BMI and SSI have a statistically significant relation with the incidence of IH in multivariate analysis (p < 0.01). No statistical difference between right and left colectomy was observed (6.6 vs. 6.4%, respectively).
  
  
  CONCLUSIONS
  The incidence of IH after LCRS seems to be acceptable. BMI over 30 kg/m(2) and SSI are strongly associated to this complication.
authors.affiliation: Division of Abdominal Wall Surgery, Department of General Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina, esadava@hospitalaleman.com.
authors.forename: Emmanuel E
authors.initials: EE
authors.lastname: Sadava
authors.forename: Javier
authors.initials: J
authors.lastname: Kerman Cabo
authors.forename: Federico H E
authors.initials: FH
authors.lastname: Carballo
authors.forename: Maximiliano E
authors.initials: ME
authors.lastname: Bun
authors.forename: Nicolás A
authors.initials: NA
authors.lastname: Rotholtz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001118:Argentina / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003108:Colonic Diseases / Q000601:surgery; D003107:Colorectal Surgery / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D046449:Hernia, Abdominal / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D015994:Incidence; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012002:Rectal Diseases / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult