Analysis of morphological patterns in incisional hernias following different surgical approaches

Incisional hernia (IH) is a common complication after colorectal cancer surgery that can impair quality of life and require reoperation. However, the anatomical distribution of IH according to surgical approach and the influence of patient-related factors on hernia morphology remain poorly characterized.

We retrospectively analyzed patients who underwent elective colorectal cancer surgery between 2009 and 2022, and included in the analysis the 464 patients who met the eligibility criteria. Patients were grouped by surgical approach: laparoscopic, upper-midline incision, or lower-midline incision. IH was diagnosed on postoperative computed tomography (CT) during at least 3 years of follow-up. Using CT data, spatial distribution, hernia midpoint (mean of the superior and inferior fascial margins) and longitudinal length were analyzed. Associations with clinical factors-including age, BMI, diabetes mellitus (DM), and pathological stage-were assessed using univariate and multivariable linear regression.

IH developed in 82 of 464 patients (18%). Density mapping demonstrated approach-specific spatial patterns: after upper-midline incisions, hernias clustered predominantly in the European Hernia Society M3 region, whereas hernias following lower-midline incisions were concentrated below the arcuate line in the M4 region. Hernia midpoint was not associated with patient factors, whereas hernia length was independently associated with DM and advanced tumor stage in lower-midline incisions.

IH after colorectal cancer surgery shows approach-specific anatomical patterns reflecting regional abdominal wall vulnerability. These findings support anatomically guided risk stratification and may inform region-specific closure and prevention strategies.