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Publications

Journal Article Ahead of print

PubMed: 42114468 DOI: 10.1016/j.surg.2026.110246

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

Surgery 196:110246

Authors: Masahiro Yamane, Atsushi Oba, Yui Sawa, Yoshiyuki Shibata, Kota Sugiura, Gaku Shimane, Ryota Ito, Hayato Baba, Satoshi Tsuchiya, Aya Maekawa, Sho Kiritani, Kosuke Kobayashi, Yoshihiro Ono, Hiromichi Ito, Yosuke Inoue, Daisuke Ban, Yu Takahashi

Affiliations

  • Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan; Department of Hepatobiliary and Pancreatic Surgery, Institute of Science, Tokyo, Tokyo, Japan.
  • Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan; Department of Hepatobiliary and Pancreatic Surgery, Institute of Science, Tokyo, Tokyo, Japan.
  • Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
  • Department of Diagnostic Ultrasound and Interventional Radiology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
  • Department of Hepatobiliary and Pancreatic Surgery, Institute of Science, Tokyo, Tokyo, Japan.

Abstract

BACKGROUND

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.

METHODS

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.

RESULTS

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).

CONCLUSION

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.

MeSH

Hernia, Incidence, Tomography, Hepatectomy, Polydioxanone, General Surgery, Incisional Hernia