Journal of Minimally Invasive Surgery 2022; 25(1): 9-10
Risk of incisional hernia after laparoscopic colorectal surgery: surgeon’s worries and challenges
Byung Mo Kang
Department of Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
Correspondence to: Byung Mo Kang
Department of Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, 77 Sakju-ro, Chuncheon 24253, Korea
Tel: +82-33-240-5787
Fax: +82-33-240-5787
Received: March 4, 2022; Revised: March 10, 2022; Accepted: March 12, 2022; Published online: March 15, 2022.
© The Korean Society of Endo-Laparoscopic & Robotic Surgery.

cc This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
The incidence and risk factors of incisional hernia after laparoscopic surgery for colorectal disease have not yet been fully investigated. The surgeon should always consider several potential risk factors of incisional hernia when closing the abdominal wall in laparoscopic colorectal surgery.
Keywords: Incisional hernia, Laparoscopy, Colorectal surgery

Previous studies have reported an incidence of incisional hernia between 0% to 44% after midline laparotomy [1] and about 50% of cases of incisional hernia occur within 2 years postoperatively [2]. In the United States, approximately 100,000 to 150,000 repairs for incisional hernia are performed annually [3], and surgeons are significantly concerned about this common postoperative complication as it negatively impacts patient quality of life and even results in intestinal obstruction or strangulation. Therefore, many researchers have attempted to identify the risk factors and adequate repair methods for incisional hernia. Currently, wound infection, high body mass index (BMI), female, and old age are generally accepted risk factors for incisional hernia [46].

As the adoption of laparoscopic surgery has grown, becoming widely and routinely performed, and the incision length of laparoscopic surgery is shorter than open surgery, the incidence of incisional hernia was expected to decrease. For colorectal diseases, several studies have evaluated the impact of laparoscopic surgery on the occurrence of incisional hernia. The LAFA (Laparoscopy and/or Fast Track Multimodal Management Versus Standard Care) study using multivariable regression analysis reported that laparoscopic colonic surgery was a protective factor for incisional hernia [7]. Similarly, a meta-analysis of seven randomized controlled trials (RCTs) and 14 non-RCTs showed that laparoscopic colorectal surgery was associated with a reduced incidence of incisional hernia compared to open surgery [8]. However, several other studies that evaluated the incidence and risk factors of incisional hernia after laparoscopic surgery reported inconsistent results.

The aim of this retrospective study was to identify risk factors of incisional hernia after laparoscopic colorectal surgery at 12 months postoperatively. This retrospective study reported that female, high BMI, and liver disease were independent risk factors for incisional hernia after laparoscopic colorectal surgery; however, suture materials like Vicryl (multifilament polyglactin suture; Ethicon Inc., Somerville, NJ, USA) and PDS (monofilament polydioxanone suture; Ethicon Inc.) for fascial closure were not associated with the occurrence of incisional hernia. These findings, with those of previous studies, provide an important alarm to surgeons performing laparoscopic colorectal surgery. However, the results of this study are not confirmative because of its retrospective design with relatively few patients operated by a single surgeon and relatively short follow-up period. A future prospective and large-scale study is needed to better understand the occurrence of incisional hernia at the minilaparotomy site and trocar-inserted site in laparoscopic colorectal surgery.


Conflict of interest

The author has no conflicts of interest to declare.



  1. Bosanquet DC, Ansell J, Abdelrahman T, et al. Systematic review and meta-regression of factors affecting midline incisional hernia rates: analysis of 14,618 patients. PLoS One 2015;10:e0138745.
    Pubmed KoreaMed CrossRef
  2. Awaiz A, Rahman F, Hossain MB, et al. Meta-analysis and systematic review of laparoscopic versus open mesh repair for elective incisional hernia. Hernia 2015;19:449-463.
    Pubmed CrossRef
  3. Read RC, Yoder G. Recent trends in the management of incisional herniation. Arch Surg 1989;124:485-488.
    Pubmed CrossRef
  4. Walming S, Angenete E, Block M, Bock D, Gessler B, Haglind E. Retrospective review of risk factors for surgical wound dehiscence and incisional hernia. BMC Surg 2017;17:19.
    Pubmed KoreaMed CrossRef
  5. Itatsu K, Yokoyama Y, Sugawara G, et al. Incidence of and risk factors for incisional hernia after abdominal surgery. Br J Surg 2014;101:1439-1447.
    Pubmed CrossRef
  6. Barranquero AG, Tobaruela E, Bajawi M, Muñoz P, Die Trill J, Garcia-Perez JC. Incidence and risk factors for incisional hernia after temporary loop ileostomy closure: choosing candidates for prophylactic mesh placement. Hernia 2020;24:93-98.
    Pubmed CrossRef
  7. Bartels SA, Vlug MS, Hollmann MW, et al. Small bowel obstruction, incisional hernia and survival after laparoscopic and open colonic resection (LAFA study). Br J Surg 2014;101:1153-1159.
    Pubmed CrossRef
  8. Pecorelli N, Greco M, Amodeo S, Braga M. Small bowel obstruction and incisional hernia after laparoscopic and open colorectal surgery: a meta-analysis of comparative trials. Surg Endosc 2017;31:85-99.
    Pubmed CrossRef

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