Relationship Between Diverticular Disease and Incisional Hernia After Elective Colectomy: a Population-Based Study

Area of Science:

• Gastroenterology
• Surgical Oncology
• Abdominal Surgery

Background:

• Genetic links between diverticular disease and connective tissue disorders suggest shared etiologies with abdominal wall hernias.
• Limited data exists on the clinical implications of this shared etiology, especially concerning laparoscopic surgery.

Purpose of the Study:

• To investigate the incidence of incisional hernias after elective sigmoid and left hemicolectomy for diverticulitis versus colon cancer.
• To compare hernia rates between open and laparoscopic colectomy approaches in these patient groups.

Main Methods:

• Utilized the New York Statewide Planning and Research Cooperative System database (2010-2016).
• Included adult patients undergoing elective sigmoid/left hemicolectomy for diverticulitis or colon cancer.
• Compared incisional hernia diagnosis and repair rates using competing risks regression, adjusting for covariates.

Main Results:

• A cohort of 8279 patients was analyzed; 82.2% for diverticulitis and 17.8% for colon cancer.
• The 5-year incisional hernia risk was 3.5% for colon cancer patients vs. 10.7% (open) and 7.2% (laparoscopic) for diverticulitis patients.
• Diverticulitis patients had a two-fold increased risk of hernia diagnosis and repair (aHR 1.8 and 2.1, respectively).

Conclusions:

• Elective colectomy for diverticulitis is associated with higher incisional hernia rates than for colon cancer, even with laparoscopic approaches.
• Surgeons should emphasize evidence-based fascial closure techniques during diverticulitis resections to mitigate hernia risk.