Tamai Koki, Tei Mitsuyoshi, Tsujimura Naoto, Nishida Kentaro, Mori Soichiro, Yoshikawa Yukihiro, Nomura Masatoshi, Ohara Nobuyoshi, Hamakawa Takuya, Takiuchi Daisuke, Tsujie Masanori, Akamaru Yusuke
Department of Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai, Osaka, 591-8025, Japan.
Surg Today. 2025 Sep 14. doi: 10.1007/s00595-025-03131-w.
Incisional hernia (IH) often develops during surveillance after colorectal cancer surgery, with repair sometimes delayed due to the risk of recurrence. This study aimed to identify the risk factors for IH enlargement by objectively measuring the changes in defect size.
We retrospectively analyzed 83 patients who developed IH after curative laparoscopic colorectal surgery at the Osaka Rosai Hospital between 2017 and 2021. Computed tomography was used to measure the IH defect sizes at diagnosis and at the end of the surveillance. Univariate and multivariate analyses were performed to determine the risk factors for enlargement.
The median IH defect size increased from 23.7 to 32.7 mm over a median follow-up of 1003 days. The highest quartile of defect size change was 12.1 mm and was used to classify patients into stable and enlarged IH groups. A multivariate analysis revealed that a high body mass index (≥ 25 kg/m; odds ratio [OR] 3.527, p = 0.037), early IH discovery (< 225 days after surgery; OR 4.753, p = 0.012), and high neutrophil-to-lymphocyte ratio (> 2.45; OR 3.604, p = 0.031) were independent risk factors for IH enlargement.
Obesity, early IH development, and systemic inflammation are associated with IH progression. Careful monitoring of patients with these risk factors is warranted.
切口疝（IH）常在结直肠癌手术后的监测期间发生，有时因复发风险而延迟修复。本研究旨在通过客观测量缺损大小的变化来确定IH扩大的危险因素。
我们回顾性分析了2017年至2021年期间在大阪罗赛医院接受根治性腹腔镜结直肠癌手术后发生IH的83例患者。使用计算机断层扫描在诊断时和监测结束时测量IH缺损大小。进行单因素和多因素分析以确定扩大的危险因素。
在中位随访1003天期间，IH缺损大小的中位数从23.7毫米增加到32.7毫米。缺损大小变化的最高四分位数为12.1毫米，用于将患者分为稳定型和扩大型IH组。多因素分析显示，高体重指数（≥25kg/m；比值比[OR]3.527，p=0.037）、早期发现IH（术后<225天；OR 4.753，p=0.012）和高中性粒细胞与淋巴细胞比值（>2.45；OR 3.604，p=0.031）是IH扩大的独立危险因素。
肥胖、早期发生IH和全身炎症与IH进展相关。对有这些危险因素的患者进行仔细监测是必要的。
