Subcutaneous fat area as a risk factor for extraction site incisional hernia following gastrectomy for gastric cancer
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ORIGINAL ARTICLE
Subcutaneous fat area as a risk factor for extraction site incisional hernia following gastrectomy for gastric cancer Sheryl Valencia1 · Koji Shindo1 · Taiki Moriyama1 · Kenoki Ohuchida1 · Daisuke Tsurumaru2 · Michael Chua3 · Hsiang‑Chih Chen4 · Lei Yao1 · Takao Ohtsuka1 · Shuji Shimizu1 · Masafumi Nakamura1 Received: 16 February 2020 / Accepted: 26 April 2020 © Springer Nature Singapore Pte Ltd. 2020
Abstract Purpose To identify the incidence of extraction site incisional hernia following gastrectomy for gastric cancer and its significant risk factors, including the subcutaneous fat area. Methods We reviewed data gathered prospectively on patients with gastric cancer, who underwent gastrectomy between 2008 and 2012 at Kyushu University Hospital, Fukuoka, Japan. The subcutaneous fat area (SFA) and visceral fat area (VFA) were measured using axial computed tomography at the level of the L4 and L3 transverse processes, and the L2–L3 intervertebral disc. The primary endpoint of the rate of extraction site incisional hernia was based on the computed tomography and clinical data including hospital follow-up reports. Results After applying the inclusion and exclusion criteria, 320 patients were included in this retrospective analysis: 3.1% (10/320) had extraction site incisional hernias after a mean follow-up of 11 months. Multivariate analysis revealed that age and the SFA were independent risk factors (age ≥ 70.5 years: P = .013, odds ratio: 9.116, 95% confidence interval 1.581– 52.553; L4 SFA ≥ 124 cm2: P = .004, odds ratio: 13.752, 95% confidence interval 2.290–82.582). Conclusion Age and the SFA were independent risk factors for extraction site incisional hernia in patients undergoing gastrectomy for gastric cancer. Keywords Incisional hernia · Gastrectomy · Risk factors · Subcutaneous fat area · Visceral fat area
Introduction Incisional hernia is a common cause of postoperative morbidity with a high recurrence rate (14–63%) despite developments in repair methods [1–4]. Approximately 23–60% of patients are asymptomatic [1, 5]; however, it can lead to life-threatening events such as incarceration (6–15%) and bowel strangulation (2%) [1, 2, 4, 6–8]. The incidence of incisional hernia is decreasing in line with the increasing popularity of laparoscopic surgery [9]. However, incisional * Kenoki Ohuchida [email protected]‑u.ac.jp 1
Department of Surgery and Oncology, Kyushu University, Fukuoka, Japan
2
Department of Clinical Radiology, Kyushu University, Fukuoka, Japan
3
St. Luke’s Medical Center, Quezon City, Philippines
4
National Taiwan University Hospital, Taipei, Taiwan
hernia remains a major late postoperative complication that affects up to 2.8% of patients undergoing laparoscopic distal gastrectomy, 20% of those undergoing laparotomy, 8.5–29% of those undergoing laparoscopic colorectal surgery, and as many as 69.1% of those undergoing abdominal aortic occlusive and aneurysmal disease surgery [10–15]. Several studies have analyzed the risk factors for incisional her
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