Open Access

ARTICLE

Incisional hernia after cystectomy: incidence, risk factors and anthropometric predisposition

Daniel C. Edwards¹, David B. Cahn², Madhu Reddy³, Dana Kivlin⁴, Aseem Malhotra⁵, Tianyu Li⁶, David Y.T. Chen², Rosalia Viterbo², Robert G. Uzzo², Richard E. Greenberg², Marc C. Smaldone², Paul Curcillo⁷, Alexander Kutikov²

1 Department of Urology, Hahnemann University Hospital/Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
2 Department of Surgical Oncology-Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
3 Department of Urology, University of California - San Diego, San Diego, California, USA
4 Department of Urology, Middlesex Hospital, Middletown, Connecticut, USA
5 Department of Urology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
6 Department of Biostatistics and Bioinformatics, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
7 Department of Surgical Oncology-Division of Minimally Invasive Surgery, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
Address correspondence to Dr. Daniel C. Edwards, 133 Ellsworth Street, Philadelphia, PA 19147 USA

Canadian Journal of Urology 2018, 25(6), 9573-9578.

Abstract

Introduction: Postoperative incisional hernias (PIH) are an established complication of abdominal surgery, with rates after radical cystectomy (RC) poorly defined. The objective of this analysis is to compare rates and risk factors of PIH after open (ORC) and robotic-assisted (RARC) cystectomy at a tertiary-care referral center.
Materials and methods: We performed a retrospective review of patients undergoing ORC and RARC from 2000-2015 with pre- and postoperative cross-sectional imaging available. Images were evaluated for anthropometric measurements and the presence of postoperative radiographic PIH (RPIH). Patient demographics, type of urinary diversion, and postoperative hernia repair (PHR) were also assessed.
Results: Of the patients that met inclusion criteria (n = 469), the incidence of RPIH and PHR were 14.3% and 9.0%, respectively. Between ORC and RARC, analysis revealed no statistically significant differences in rates of RPIH (13.6% versus 20.3%, p = 0.152) or PHR (8.2% versus 12.5%, p = 0.214). Body mass index was associated with a slightly increased likelihood of RPIH on univariate analysis alone (OR 1.08, p = 0.008). Ileal conduit was associated with a decreased likelihood of RPIH (OR 0.42, p = 0.034) and PHR (OR 0.36, p = 0.023). Supraumbilical rectus diastasis width (RDW) was an independent predictor of both RPIH (OR 1.52, p = 0.023) and PHR (OR 1.43, p = 0.039) on multivariate analysis.
Conclusions: Patients undergoing RC are at significant risk of RPIH and PHR regardless of surgical approach. Anthropomorphic factors and urinary diversion type appear to be associated with PIH risk. Further research is needed to understand how risks of PIH can be reduced in patients undergoing cystectomy.

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