Incisional Hernia after Pancreaticoduodenectomy: A Systematic Review and Meta-Analysis of Incidence and Risk Factors

Pancreaticoduodenectomy (PD) is a high-risk surgical procedure associated with significant postoperative morbidity. While complications such as pancreatic fistula and delayed gastric emptying are well-studied, the incidence and risk factors of incisional hernia (IH) following PD remain poorly characterized. This systematic review and meta-analysis aimed to evaluate the incidence of IH and identify associated risk factors in patients undergoing PD.

We conducted a systematic search of PubMed, Embase, CENTRAL, and Web of Science databases from inception to December 2024, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies reporting IH incidence after PD were included. The primary outcome was the pooled incidence of IH. Secondary outcomes included risk factors associated with IH. A random-effects model was used for meta-analyses, and heterogeneity was assessed using I² statistics. Risk of bias was evaluated using the ROBINS-I tool.

A total of 6 studies comprising 1929 patients met inclusion criteria. The pooled incidence of IH following open PD was 6% (95% CI: 2%-15%), with substantial heterogeneity (I² = 94%). Risk factors significantly associated with IH included BMI ≥ 30 kg/m² (OR range: 1.67-2.6), preoperative hypoalbuminemia (OR 3.4; 95% CI: 1.2-9.4), chronic obstructive pulmonary disease (HR 24.4; 95% CI: 1.6-391.9), elevated preoperative CRP (HR 11.4; 95% CI: 1.2-103.1), postoperative fascial dehiscence (HR 14.1; 95% CI: 1.10-180.4), and wound infection (OR 2.9; 95% CI: 1.8-4.6). Sensitivity analyses confirmed the robustness of incidence estimates.

IH is a relatively underrecognized yet significant complication following PD, with a pooled incidence of 6%. Several modifiable and non-modifiable risk factors contribute to its development. These findings underscore the need for targeted preventive strategies in high-risk patients and further research to inform surgical decision-making and postoperative care.