Incisional hernia in gynecologic oncology patients: A 10-year study

Objective: To evaluate the independent contribution of clinical and constit utional factors in the development of early acid late incisional hernias in women undergoing surgery for uterine cancer. Methods: Over 10 years, patients undergoing extended abdominal hysterectomy for cervical or endometrial malignancies through a vertical incision were followed for the identification of incisional hernias. Logistic regression and survival analyses were used for statistics. Results: Four hundred fifty-five women were included in the study, 77 of wh om (16.9%) developed incisional hernias. The median (range) body mass index was higher in women who developed an incisional hernia than in those who d id not (28 [19-44] kg/m(2) versus 24 [16-411 kg/m(2); P <.01). The frequenc ies of diabetes (14.3% versus 4.8%; P <.01), wound sepsis (10.4% versus 1.3 %; P <.05), and fascial closure with interrupted sutures (70.1% versus 55.6 %; P <.05) were significantly higher in women with incisional hernia than i n those without. Multiple logistic regression revealed that, after adjustme nt for confounding variables, the only factors associated with incisional h ernia formation within 1 year from the operation were body mass index above 27 kg/m(2) (odds ratio [OR] 3.68; 95% confidence interval [CI] 1.38, 9.81; P <.01) and wound infection (OR 5.05; 95% CI 1.39, 18.37; P <.01), whereas the factors associated with incisional hernia formation at least 3 years a fter surgery were diabetes (OR 6.68; 95% CI 2.02, 22; P <.01) and wound inf ection (OR 8.55; 95% CI 1.54, 47.5; P <.01). For hernia developing after 5 years (OR 8.32; 95% CI 1.41, 55.65; P <.05) and 8 years (OR 49.52; 95% CI 2 .72, 907.14; P <.01), the only significant association was found with diabe tes. Conclusion: Late incisional hernia formation does not depend on conditions present at the time of operation or on surgical technique. Other factors su ch as diabetes seem to play an important role in the development of late in cisional hernia. (Obstet Gynecol 2001;97:696-700. (C) 2001 by The American College of Obstetricians and Gynecologists.).