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Subcutaneous Fat, Not Visceral Fat, as a Risk Factor for Incisional Hernia After Laparoscopic Colorectal Cancer

Kumiko Sekiguchi1,2, Akihisa Matsuda3, Takeshi Yamada3

  • 1Department of Gastroenterological Surgery, Nippon Medical School Musashikosugi Hospital, Kawasaki, Japan.

Asian Journal of Endoscopic Surgery
|November 21, 2025
PubMed
Summary

High subcutaneous fat area (SFA) is a significant risk factor for incisional hernia after laparoscopic colorectal surgery. Subcutaneous fat thickness (SFT) can be a practical indicator for predicting hernia risk.

Keywords:
incisional hernialaparoscopic colorectal cancer surgerysubcutaneous fat areasubcutaneous fat thickness

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Area of Science:

  • Abdominal Surgery
  • Oncology
  • Radiology

Background:

  • Postoperative incisional hernia negatively impacts patient quality of life and may necessitate surgical repair.
  • Laparitic colorectal cancer surgery poses a risk for incisional hernia development.

Purpose of the Study:

  • To investigate the association between body composition, specifically subcutaneous fat area (SFA) and visceral fat area (VFA), and the incidence of incisional hernia following laparoscopic colorectal cancer surgery.
  • To identify independent risk factors for incisional hernia in this patient population.

Main Methods:

  • A retrospective study of 199 patients undergoing laparoscopic colorectal cancer surgery.
  • Measurement of subcutaneous fat area (SFA) and visceral fat area (VFA) using computed tomography imaging.
  • Analysis of risk factors including body mass index, SFA, and VFA, with validation in an independent cohort.

Main Results:

  • Incisional hernia occurred in 4.6% of patients.
  • Higher body mass index, SFA, and VFA were observed in patients who developed incisional hernias.
  • Elevated SFA (≥167.8 cm²) emerged as an independent risk factor for incisional hernia (OR: 7.73, p=0.02).
  • Subcutaneous fat thickness (SFT) demonstrated a strong correlation with SFA and was significantly associated with incisional hernia, confirmed in a validation cohort.

Conclusions:

  • Increased subcutaneous fat area (SFA) is a significant independent risk factor for developing incisional hernias after laparoscopic colorectal cancer surgery.
  • Subcutaneous fat thickness (SFT) is a readily measurable parameter that can serve as a practical surrogate for SFA in assessing incisional hernia risk.