Midline extraction incision predicts risk of incisional hernia after nephrectomy

A midline extraction incision appears to contribute to a greater risk of incisional hernia (IH) following a minimally invasive nephrectomy, according to a study.

Researchers performed an observational study of a prospectively maintained database of patients who underwent minimally invasive nephrectomy from 2005 to 2022. Those who had preoperative and 1- and 2-year postoperative abdominal cross-sectional imaging were included in the analysis.

The research team calculated skeletal muscle and fat mass indices based on measurements taken from preoperative imaging. They also determined the location of the specimen extraction incision from operative reports and diagnosed IH upon review of postoperative imaging. Finally, the predictors of IH were identified via logistic regression analysis.

Overall, 494 patients met the eligibility criteria. Gibson was the most common extraction incision used (250 patients, 51 percent), followed by midline (98 patients, 20 percent), paramedian (58 patients, 12 percent), and Pfannenstiel (21 patients, 4.3 percent).

Fifty-nine patients (12 percent) developed IH over 2 years of postoperative follow-up. IH incidence was highest among those who underwent midline incision (23 percent) compared with all other types (≤10 percent each).

Notably, baseline fat mass index (odds ratio [OR], 1.18, 95 percent confidence interval [CI], 1.06‒1.32; p=0.002) and midline extraction incision (OR, 4.60, 95 percent CI, 2.23‒9.48; p<0.001) independently predicted the incidence of IH.

“Body morphometry analysis did not improve predictive models compared with models using BMI,” the researchers said. “These data support a prospective trial to identify the optimal extraction incision for hernia-free survival and patient-reported quality of life.”