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Association Between Midline Extraction Incision and Increased Risk of Incisional Hernia After Minimally Invasive
Zaeem Lone1, Shelby Harper1, David Shin2
1Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio.
The Journal of Urology
|June 18, 2025
Summary
A midline incision for specimen extraction during minimally invasive nephrectomy significantly increases the risk of incisional hernia (IH). Body morphometry did not improve IH prediction beyond body mass index, suggesting a need for further research on optimal incision techniques.
Area of Science:
- Urology
- Surgical Oncology
- Abdominal Surgery
Background:
- Incisional hernia (IH) is a potential complication following minimally invasive nephrectomy.
- Identifying predictive factors for IH is crucial for patient outcomes.
Purpose of the Study:
- To evaluate if specimen extraction incision type and body morphometry (skeletal muscle and fat mass) predict incisional hernia (IH) after minimally invasive nephrectomy.
Main Methods:
- Observational study using a prospectively maintained database (2005-2022).
- Included patients with preoperative and 1- and 2-year postoperative imaging.
- Calculated skeletal muscle and fat mass indices from preoperative imaging.
- Determined IH from postoperative imaging and logistic regression analysis.
Main Results:
- 494 patients met inclusion criteria; 12% developed IH by 2 years.
- Midline incisions had the highest IH incidence (23%) compared to other types (≤10%).
- Baseline fat mass index (OR: 1.18) and midline extraction incision (OR: 4.60) independently predicted IH.
Conclusions:
- Midline extraction incisions are associated with a significantly higher risk of IH post-minimally invasive nephrectomy.
- Body morphometry analysis did not enhance IH predictive models over BMI.
- Further prospective trials are warranted to determine optimal extraction incisions for hernia-free survival and quality of life.
