Outcome of and risk factors for incisional hernia after partial hepatectomy.

INTRODUCTION

This study was conducted to analyze differences among abdominal incisions, and risk factors for incisional hernia after partial hepatectomy.

MATERIALS AND METHODS

In 626 posthepatectomy cases, we analyzed retrospectively the distribution regarding the type of incision and assessed risk factors for incisional hernia.

RESULTS

Of the patients, 95 (15.2%) had median incisions, 233 (37.2%) had J-shaped incisions, 206 (32.9%) had right transverse incisions with vertical extensions in the midline from the subumbilical region to the xiphoid process (RTVE), and 92 (14.7%) had bilateral transverse incision with a vertical extension to the xiphoid process (a reversed T incision). The respective frequencies of incisional hernia after median, J-shaped, RTVE, and reversed T incisions were 6.3, 4.7, 5.4, and 21.7%, so that the difference between reversed T and other incisions was significant. A diagnosis of "no hernia" required a minimum follow-up of 12 months. The risk factors for incisional hernia were incision type, postoperative ascites, body mass index, repeat hepatectomy, and steroid use in multivariate analysis.

CONCLUSION

The incidence of incisional hernia after reversed T incision was significantly higher than after other incisions. If incision extension is necessary, the midline incision should be extended from the subumbilical region.