Incisional hernia after major pancreatic resection: long term risk assessment from two distinct sources – A large multi-institutional network and a single high-volume center

Abstract

BackgroundPost-operative incisional hernia (IH) is a common complication following abdominal surgery. Data regarding IH after major pancreatic surgery are limited. We aim to evaluate the long-term risk of IH following major pancreatic resection. MethodsA dual-approach study: a large multi-institutional research network (RN) was investigated for IH incidence and risk factors in propensity-score matched survivors after pancreaticoduodenectomy (PD) and distal pancreatectomy (DP), was complemented by a patient-reported questionnaire assessing IH incidence administered to a cohort of pancreatic surgery survivors. ResultsRN analysis identified 22,113 patients that underwent pancreatic surgery and created 7092 matched PD and DP patient pairs (follow-up > 1 year). 11.0% of PD patients and 8.6% of DP patients developed IH (P < 0.0001). IH rates were higher with open surgery compared with minimally invasive approaches in PD (OR = 1.56, P = 0.03) and DP (OR = 1.94, P = 0.003). BMI>35 was found to correlate with increased IH rates for PD and DP (OR = 1.87, and OR = 1.86, respectively, P < 0.0001 each), as did postoperative intraabdominal infections and anastomotic leaks (OR = 1.53, and OR = 1.59, respectively, P < 0.0001 each). Patient-based survey of 104 patients, revealed that 16 patients (15%) reported post-operative IH during the follow-up period. BMI≥30, SSI and intra-abdominal abscess were associated with increased IH risk (P < 0.05). ConclusionImproved survival after pancreatic resection has led to an increased prevalence of long-term surgical sequela. In this study, we demonstrate significant rates of IH among long-term survivors and assess potential risk factors.