Risk Factors for incisional hernia development after pancreatic surgeries: a systematic review and meta-analysis

The development of incisional hernias (IH) is an uncommon but complex outcome following pancreatic surgery, especially through the open approaches. The etiology of this complication is multifactorial and can be related to the patient and to the surgical technique. We aimed to perform a systematic review and meta-analysis assessing the risk factors for development of IH following pancreatic surgery. Pubmed, Cochrane, and EMBASE databases were systematically searched from inception to September 2024. Observational studies and randomized controlled trials assessing patients > 18 years old undergoing pancreatic surgery and reporting data on incidence and risk factors for IH were selected. Outcomes were mean age, mean body mass index (BMI), diabetes mellitus, female and male gender, active smoking, and surgical site infections (SSI). We used RStudio for statistical analysis. 686 records were reviewed, and 7 observational retrospective studies were included, totaling 3,391 patients. The incidence of IH in the pooled analysis was 368 (10.8%), and after performing a proportional meta-analysis, we found that 12.5 per 100 (95% CI 7.1, 20.9) patients undergoing pancreatic surgery develop IH. Our pooled analysis found that older patients (MD 2.7 years; 95% CI 0.5, 4.8; p = 0.014) and patients with higher BMI (MD 1.8; 95% CI 0.9, 2.7; p < 0.001) present higher risk of developing IH. Female and male gender, active smoking, diabetes mellitus, and SSI were not significant risk factors for IH after pancreatic surgery. Our study showed that patients with older age and higher weight present a significantly higher risk of developing IH after pancreatic surgery. Considering pancreatic surgery is frequently carried out in emergent conditions, sometimes due to malignant causes, the preoperative optimization to reduce weight before surgery is not always a possible alternative. On the other hand, surgeons must consider the possibility of optimizing the patient in terms of weight loss if feasible, to reduce morbidity after the procedure.