title: Type of incision does not predict abdominal wall outcome after emergency surgery for colonic anastomotic leakage.
abstract: OBJECTIVE
  Most literature on abdominal incision is based on patients undergoing elective surgery. In a cohort of patients with anastomotic leakage after colonic cancer resection, we analyzed the association between type of incision, fascial dehiscence, and incisional hernia.
  
  
  METHODS
  Data were extracted from the Danish Colorectal Cancer Group database and merged with information from the Danish National Patient Register. All patients with anastomotic leakage after colonic resection in Denmark from 2001 until 2008 were included and surgical records on re-operations were retrieved. The primary outcome of the study was incisional hernia formation, and the secondary outcome was fascial dehiscence. Multivariable logistic, Cox, and competing risks regression analysis, as well as propensity score matching were used for confounder control.
  
  
  RESULTS
  A total of 363 patients undergoing reoperation for anastomotic leakage were included with a median follow-up of 5.4 years. Incisional hernia occurred in 41 of 227 (15.3%) patients undergoing midline incision compared with 14 of 81 (14.7%) following transverse incision, P = 1.00. After adjusting for confounders, there was no association between the type of incision and incisional hernia (transverse incision hazard ratio 1.36, 0.68-2.72, P = 0.390) or fascial dehiscence (transverse incision odds ratio 1.66, 0.57-4.49, P = 0.331). This conclusion was confirmed after propensity score matching, P = 0.507.
  
  
  CONCLUSIONS
  In the current study, type of incision did not predict abdominal wall outcome after emergency surgery for colonic anastomotic leakage.
authors.affiliation: Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, DK-2400, Copenhagen, NV, Denmark. mail@kristiankiim.dk.
authors.forename: Kristian Kiim
authors.initials: KK
authors.lastname: Jensen
authors.affiliation: Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, DK-2400, Copenhagen, NV, Denmark.
authors.forename: Erling
authors.initials: E
authors.lastname: Oma
authors.affiliation: Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, DK-2400, Copenhagen, NV, Denmark.
authors.forename: Henrik
authors.initials: H
authors.lastname: Harling
authors.affiliation: Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, DK-2400, Copenhagen, NV, Denmark.|Danish Colorectal Cancer Group, Copenhagen, Denmark.
authors.forename: Peter-Martin
authors.initials: PM
authors.lastname: Krarup
mesh_terms: D034861:Abdominal Wall / Q000473:pathology / Q000601:surgery*; D000368:Aged; D057868:Anastomotic Leak / Q000473:pathology / Q000601:surgery*; D003110:Colonic Neoplasms / Q000473:pathology / Q000601:surgery*; D005205:Fascia / Q000473:pathology; D005260:Female; D006547:Hernia / Q000209:etiology; D006801:Humans; D015994:Incidence; D007813:Laparotomy; D008297:Male; D015999:Multivariate Analysis; D013529:Surgical Wound Dehiscence / Q000209:etiology
keywords: Burst abdomen; Colonic cancer; Fascial dehiscence; Incisional hernia; Ventral hernia