title: Visceral obesity, not elevated BMI, is strongly associated with incisional hernia after colorectal surgery.
abstract: BACKGROUND
  High BMI is often used as a proxy for obesity and has been considered a risk factor for the development of an incisional hernia after abdominal surgery. However, BMI does not accurately reflect fat distribution.
  
  
  OBJECTIVE
  The purpose of this work was to investigate the relationship among different obesity measurements and the risk of incisional hernia.
  
  
  METHODS
  This was a retrospective cohort study.
  
  
  METHODS
  The study included a single academic institution in New York from 2003 to 2010.
  
  
  METHODS
  The study consists of 193 patients who underwent colorectal cancer resection.
  
  
  METHODS
  Preoperative CT scans were used to measure visceral fat volume, subcutaneous fat volume, total fat volume, and waist circumference. A diagnosis of incisional hernia was made either through physical examination in medical chart documentation or CT scan.
  
  
  RESULTS
  Forty-one patients (21.2%) developed an incisional hernia. The median time to hernia was 12.4 months. After adjusting for patient and surgical characteristics using Cox regression analysis, visceral obesity (HR 2.04, 95% CI 1.07-3.91) and history of an inguinal hernia (HR 2.40, 95% CI 1.09-5.25) were significant risk factors for incisional hernia. Laparoscopic resection using a transverse extraction site led to a >75% reduction in the risk of incisional hernia (HR 0.23, 95% CI 0.07-0.76). BMI > 30 kg/m was not significantly associated with incisional hernia development.
  
  
  CONCLUSIONS
  Limitations include the retrospective design without standardized follow-up to detect hernias and the small sample size attributed to inadequate or unavailable CT scans.
  
  
  CONCLUSIONS
  Visceral obesity, history of inguinal hernia, and location of specimen extraction site are significantly associated with the development of an incisional hernia, whereas BMI is poorly associated with hernia development. These findings suggest that a lateral transverse location is the incision site of choice and that new strategies, such as prophylactic mesh placement, should be considered in viscerally obese patients.
authors.affiliation: 1Department of Surgery, Surgical Health Outcomes and Research Enterprise, University of Rochester Medical Center, Rochester, New York.
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Aquina
authors.forename: Aaron S
authors.initials: AS
authors.lastname: Rickles
authors.forename: Christian P
authors.initials: CP
authors.lastname: Probst
authors.forename: Kristin N
authors.initials: KN
authors.lastname: Kelly
authors.forename: Andrew-Paul
authors.initials: AP
authors.lastname: Deeb
authors.forename: John R T
authors.initials: JR
authors.lastname: Monson
authors.forename: Fergal J
authors.initials: FJ
authors.lastname: Fleming
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D015992:Body Mass Index; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000601:surgery*; D013505:Digestive System Surgical Procedures; D005260:Female; D006555:Hernia, Ventral / Q000453:epidemiology*; D006801:Humans; D010535:Laparoscopy; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D056128:Obesity, Abdominal / Q000453:epidemiology*; D011183:Postoperative Complications / Q000453:epidemiology*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors