Incisional hernia after inverted L-shaped incision in open hepatectomy: A topographical analysis and comparison of 2 fascial closure methods.

Abstract

Inverted L-shaped incisions used in complex open hepatectomies are associated with a high incidence of postoperative incisional hernia. The optimal fascial closure strategy for this biomechanically challenging incision remains uncertain. This study aimed to compare 2 composite fascial closure methods-the STRATAFIX-continuous method and the polydioxanone-hybrid method-and to characterize the incidence, location, and risk factors of postoperative incisional hernia. This retrospective study analyzed 346 patients who underwent open hepatectomy with inverted L-shaped incisions. Fascial closure was performed using either the polydioxanone-hybrid method (n = 223) or the STRATAFIX-continuous method (n = 123). The primary outcome was 1-year computed tomography-detected incisional hernia; secondary analyses included the topographical hernia distribution and an a priori multivariable logistic regression model for incisional hernia. The incidence of incisional hernia was lower in the STRATAFIX-continuous method group than in the polydioxanone-hybrid method group (8.1% vs 21.5%, P = .001). Topographical analysis identified the intersectional corner as the most frequent site of hernia formation. In the a priori multivariable model, the STRATAFIX-continuous method remained associated with lower odds of incisional hernia (odds ratio, 0.31; 95% confidence interval, 0.14-0.66; P = .002). In this retrospective cohort, the STRATAFIX-continuous closure method was associated with a lower rate of 1-year computed tomography-detected incisional hernia after an inverted L-shaped incision, although the independent effects of suture material and closure technique could not be separated. The intersectional corner remained the most vulnerable site, supporting investigation of targeted reinforcement strategies.