Prevalence and Risk Factors of Incisional Hernia Following Abdominal Surgery Among Yemeni Patients: A Retrospective Study

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This study aimed to determine the prevalence, timing and risk factors for IH following abdominal surgery in a high-risk patient population. Patients and Methods : A retrospective review of 222 patients who underwent abdominal surgery was conducted in two hospitals in Yemen. The demographics of the patients, surgical variables and postoperative outcomes were analyzed. The prevalence and timing of IH were determined and univariate and multivariate analyzes were performed to identify risk factors for IH. Results The overall prevalence of IH was 19%, with 57% of cases occurring within 1 year after surgery (median 11 months). In the univariate analysis, significant risk factors for IH included ASA grade (p < 0.001), smoking (p = 0.044), diabetes (p = 0.003), hypertension (p = 0.044), malnutrition (p = 0.022), trauma (p < 0.001), peritonitis (p = 0.001), surgical site infection (SSI) (p = 0.015) and wound dehiscence (p < 0.001). In multivariate analysis, only postoperative wound dehiscence (odds ratio [OR] 9.874, 95% CI 3.317–29.389, p < 0.001) and poor nutritional status (OR 9.899, 95% CI 1.777–55.161, p = 0.009) emerged as independent risk factors for IH. Conclusion Our study found a higher prevalence of IH compared to some studies and identified several risk factors, including ASA, smoking, diabetes, hypertension, malnutrition, trauma, peritonitis, SSI and wound dehiscence. Wound dehiscence and poor nutritional status emerged as independent risk factors for the development of IH. Optimizing preoperative nutrition, managing postoperative infections, and preventing wound complications to reduce the risk of IH are crucial. More research is needed to explore the complex relationships between these factors and the occurrence of IH, ultimately leading to targeted interventions that can improve patient outcomes. General Surgery Incisional hernia prevalence risk factors abdominal surgery wound dehiscence nutritional status Yemen Figures Figure 1 Plain Language Summary This study aimed to understand how often incisional hernias (IH) occur after abdominal surgery in high-risk patients and identify factors that increase the risk of developing an IH. Researchers reviewed the records of 222 patients who had abdominal surgery in Yemen. They collected information on patient characteristics, surgical details, and postoperative outcomes. The study found that 19% of patients experienced an IH, with more than half of them developing it within a year after surgery (around 11 months on average). Several factors increased the risk of IH, including preoperative health status, smoking, diabetes, high blood pressure, inadequate nutrient intake, traumatic injury, infection of the abdominal cavity lining, wound infection, and wound opening. The most closely linked factors to IH were wound opening and inadequate nutrient intake. These findings highlight the importance of ensuring patients are well-nourished before surgery, preventing postoperative infections, and promoting proper wound healing to reduce the risk of IH. Further research is needed to better understand how these factors interact and improve patient outcomes. Introduction Incisional hernia is a frequent and a common complication of abdominal surgery and can lead to significant morbidity, such as intestinal obstruction or strangulation, and increased healthcare costs. 1 , 2 It represents a breakdown or loss of continuity of fascial closure, and they are unique in that they are the only abdominal wall hernias that are considered iatrogenic. 3 The pathogenesis of incisional hernias is complex and involves factors such as type of abdominal surgery, patient characteristics, and surgical techniques. 4 , 5 Several studies have explored the incidence and risk factors for IH after abdominal surgery, with incidence rates after midline laparotomy ranging from 11–20%. 6 Furthermore, a systematic review and meta-analysis found that the incidence of incisional hernias ranged from 4.3% in the laparoscopic surgical approach to 10.1% in the open surgical approach, with a significant reduction in IH rate among laparoscopic approach. 7 Another study provided a more comprehensive understanding of long-term risk by estimating the incidence rates of incisional hernias at 12 and 24 months after surgery, which were 5.2% and 10.5%, respectively. 8 The risk factors for incisional hernias are multifaceted as the occurrence of IH depends on the presence of various risk factors, including patient-related factors (advanced age, sex, BMI, smoking history, chronic diseases), 9 – 15 disease-related factors (midline incisions, emergency surgery, stoma formation, wound infections), 16 – 23 and technical factors (poor surgical techniques, suture material). 24 , 25 Prevention involves meticulous abdominal wall closure techniques, such as continuous non-absorbable sutures, mesh reinforcement, and tension-free closure. 25 , 26 Additional strategies include optimal nutrition, smoking cessation, and managing underlying medical conditions. Continuous follow-up and adherence to preventive measures are essential to reduce the incidence of IHs. 8 Incisional hernias after abdominal surgery and their prevalence and risk factors in resource-limited settings remain poorly understood. Developing countries, such as our country, Yemen, face unique challenges in healthcare infrastructure, limited resources, and surgical practices, which can influence the incidence and characteristics of incisional hernias. The lack of previous studies on the prevalence and risk factors specific to these settings hinders the development of effective preventive strategies and optimized surgical care. Therefore, this study was of great importance to investigate the prevalence and risk factors associated with incisional hernias after abdominal surgery in resource-limited settings, with the objective of filling this knowledge gap and inform evidence-based practices for better patient care and outcomes. Material and Methods Study Design and Setting: This was a retrospective cross-sectional study conducted at two hospitals in Yemen. We reviewed the medical records of patients who underwent abdominal surgery at these institutions over a period of 3 years ( 2019 to 2021). The study is reported according to the Incisional Hernia Reporting Guidelines to facilitate comparison with other research in this field. 27 Patient Population: The study included all patients who underwent abdominal surgery during the study period and had at least 6 months of postoperative follow-up. Patients who died within 30 days after surgery or had incomplete medical records were excluded. Data Collection: Data were collected from medical records by trained abstractors using a standardized data collection form based on previous studies. Demographic data included age, sex, body mass index (BMI), physical status classification of the American Society of Anesthesiologists (ASA), and comorbidities. Surgical data included indication for surgery, type of procedure, operative approach (emergency vs. elective), specific procedure performed, intraoperative blood transfusion, wound length, closure technique, type of incision, and wound classification. Postoperative data included the occurrence of surgical site infection (SSI), wound dehiscence, and incisional hernia (IH). The timing of the IH occurrence was also recorded. Definitions: IH was defined as a protrusion of abdominal contents through the fascial defect at the site of the previous surgical incision. The diagnosis of IH was based on clinical examination by the surgical team and was confirmed by radiographic imaging in some cases. Surgical site infection was defined according to the Centers for Disease Control and Prevention (CDC) criteria. 28 Wound dehiscence was defined as the separation of the sutured edges of the abdominal fascia after surgery developed on days 3–7 postoperatively, regardless of the need for reoperation. Poor nutrition status was defined as serum albumin level < 3.5mg/dl. Follow-up: The follow-up period was defined as the time from surgery to the last clinical follow-up or the diagnosis of IH, whichever occurred first. The time of IH occurrence was recorded as the interval from surgery to the diagnosis of IH. Statistical analysis: Univariate analysis was performed to identify potential risk factors for IH. Categorical variables were compared using the chi-square test or Fisher's exact test as appropriate. Continuous variables were compared using Student's t test or Mann-Whitney U test, as appropriate. Variables with a p-value < 0.05 on univariate analysis were entered into a multivariate logistic regression model to identify independent risk factors for IH. Odds ratios (OR) with 95% confidence intervals (CI) were calculated. A p-value < 0.05 was considered statistically significant. Results During our study, a total of 300 potential eligible cases were collected from the surgical departments of 48 Modern Hospital and Military Hospital in Sana'a city, Yemen, during the study period. However, 78 patients were excluded due to incomplete medical records, which resulted in 222 eligible cases being included in the study. Data from these 222 patients were reviewed and analyzed, revealing the following findings: Demographic characteristics Most of the patients were men (84.7%, n = 188), with women comprising 15.3% (n = 34). The predominant age range was 21–40 years, comprising 64% (n = 143) of the cases, followed by those 41–60 years with 23% (n = 51). Regarding BMI, 68.9% had normal weight, 27% were overweight and 4.1% were obese. Regarding the grades of the American Society of Anesthesiologists (ASA), 51.8% were classified as grade I, 40.1% as grade II, and 8.1% as grade III. The leading comorbidities included smoking (27.9%), hypertension (19.8%), diabetes mellitus (9.5%), chronic pulmonary disease (8.1%), poor nutritional status (3.6%) and a history of preoperative chemotherapy or radiation therapy (1.8%). Abdominal surgery was performed for various indications in the studied population. The most common indication was trauma, accounting for 53.6% of the cases, followed by peritonitis at 21.6% and intestinal obstruction at 9.5%. GI tumors and hepatobiliary disorders each represented 4.5% of the indications, while gynecological disorders accounted for 2.7%. Urological disorders were observed in 1.8% of the cases and the remaining 0.9% were classified as other indications ( Table 1 ) . Table 1 Demographic Characteristics of the study population Variables No. % Gender Male 188 84.7% Female 34 15.3% Age groups 60 19 8.6% Comorbidities Smoking 62 27.9% Diabetes millets 21 9.5% Hypertension 44 19.8% Chronic obstructive pulmonary disease 18 8.1% Chronic liver disease 2 0.9% Preoperative chemotherapy 4 1.8% Poor nutritional status (albumin level < 3.5 mg/dl) 8 3.6% Body mass index 30kg/m 2 9 4.1% ASA grade I 115 51.8% II 89 40.1% III 18 8.1% Indications for abdominal surgery Trauma 119 53.6% Peritonitis 48 21.6% Intestinal obstruction 21 9.5% GI tumors 10 4.5% Hepato-biliary disorder 10 4.5% Gynecology disorder 6 2.7% Urology disorder 4 1.8% Others 2 .9% ASA: American Society of Anesthesiologists Prevalence of IH The prevalence of incisional hernia (IH) after abdominal surgery among the study population was 19%, with 42 out of 222 patients developed IH postoperatively ( Fig. 1 ) . Risk Factors for IH The univariate analysis of perioperative risk factors for incisional hernia (IH) revealed several significant associations (p < 0.05). Patients with higher ASA grades (II and III) had a significantly increased risk of IH (p < 0.001). Comorbidities such as smoking (p = 0.044), diabetes mellitus (DM) (p = 0.003), hypertension (HTN) (p = 0.044) and poor nutritional status (p = 0.022) were also significantly associated with a higher probability of IH. Trauma (p < 0.001) and peritonitis (p = 0.001) were identified as significant indications for surgery that were strongly associated with IH. Furthermore, postoperative complications, including surgical site infection (p = 0.015) and wound dehiscence (p < 0.001), showed a significant association with IH ( Table 2 ) . However, a binary regression test revealed that postoperative dehiscence emerged as a highly significant risk factor (p < 0.001) with an estimated odds ratio of 9.874 (95% CI: 3.317–29.389), indicating a substantial increase in IH risk for patients experiencing wound dehiscence. Poor nutritional status also showed a significant association (p = 0.009) with an odds ratio of 9.899 (95% CI: 1.777–55.161), indicating that patients with inadequate nutrition had a significantly higher probability of developing IH ( Table 3 ) . Table 2 Univariate Analysis of Perioperative Risk Factors for Incisional Hernia Risk factors Incisional Hernia Total p- value Patient with No.= 42 Patient without No.= 180 No.= 222 ASA grade I 11 (26.2%) 104 (57.8%) 115 (51.8%) .000* II 23 (54.8%) 66 (36.7%) 89 (40.1%) III 8 (19%) 10 (5.6%) 18 (8.1%) Comorbidities Smoking 17 (40.5%) 45 (25%) 62(27.9%) .044* DM 9 (21.4%) 12 (6.7%) 21(9.5%) .003* HTN 13 (31%) 31 (17.2%) 44(19.8%) .044* poor nutritional status 4 (9.5%) 4 (2.2%) 8 (3. %) .022* Indication for surgery Trauma 12 (28.6%) 109 (60.6%) 121(54.5%) .000* Peritonitis 17 (40.5%) 31 (17.2%) 48(21.6%) .001* Postoperative complications Surgical site infection 24 (57.1%) 57 (31.6%) 81 (36. %) .015* Wound dehiscence 20 (47.6%) 22 (12.2%) 42 (18.9%) .000* * significant p- value < 0.05 by chi-square test Table 3 Binary logistic regression analysis of perioperative risk factors for incisional hernia Risk factors Incisional Hernia Total P value Odd ration 95% CI Patient with no = 42 Patient without no = 180 no = 222 Upper Lower Wound dehiscence 20 (47.6%) 22 (12.2%) 42(18.9%) .000* 9.874 3.317 29.389 Poor nutrition 4 (9.5%) 4 (2.2%) 8 (3. %) .009* 9.899 1.777 55.161 * significant p- value < 0.05 In this study, age, sex, and BMI did not show a significant association with the occurrence of IH. Furthermore, emergency operations were more common (85.6%) compared to elective operations (14.4%), but there was no significant difference in the occurrence of incisional hernia (IH) based on the surgical approach (P = 0.118). The most common operative procedure was small intestine (40.5%), followed by large intestine (34.7%) and hepato-biliary procedures (7.7%), without significant association with IH (P = 0.360). Intraoperative blood transfusion and wound length also did not show significant associations with IH (P = 0.564, P = 0.389, respectively). The continuous non-absorbable fascial closure technique was used most frequently (66.7%), but there were no significant differences in IH rates between closure techniques (P = 0.377). Most cases had midline incisions (82.9%) and class II wound classification (42.3%), but neither the type of incision nor the class of wound class showed significant associations with IH (P = 0.936, P = 0.787, respectively). The prevalence of IH in relation to the timing of its occurrence The prevalence of incisional hernia (IH) in relation to the time of its development after surgery was examined. Among the patients who developed IH postoperatively, 57.1% (24 patients) experienced IH within the first year, resulting in a prevalence rate of 10.8%. In the second year, 28.6% (12 patients) developed IH, with a prevalence rate of 5.4%, followed by 14.3% (6 patients) in the third year, with a prevalence rate of 2.7%. The median time to develop IH after surgery was 11 months, ranging from 9 to 24 months ( Table 4 ) . Table 4 Distribution of prevalence rate of Incisional Hernia in relation to time of its occurrence Years No. of patient Valid percentage Prevalence rate 1st year 24 57.1% 10.8% 2nd year 12 28.6% 5.4% 3rd year 6 14.3% 2.7% Total 42 100.0 18.9 Discussion Our study provides a comprehensive examination of the prevalence, timing, and risk factors of incisional hernia (IH) after abdominal surgery. The overall prevalence of IH of 19% is higher than reported in some studies. 7 , 8 but comparable to others. 6 , 29 , 30 The early onset of IH in our study, with 57% of cases occurring within 1 year, aligns with the findings that the incidence of IH increases over time. 8 This highlights the importance of prolonged postoperative surveillance for the detection of IH. Our identified risk factors, including ASA grade, smoking, diabetes, hypertension, malnutrition, trauma, peritonitis, surgical site infection (SSI), and wound dehiscence, overlap with those in the literature. 9 , 14 , 18 , 23 , 31 – 33 Smoking has been established as a risk factor for IH 9 , and our study confirms this association. Similarly, diabetes and hypertension have been linked to IH in previous research. 11 The significant impact of nutritional status and infectious complications on IH development in our study underscores the importance of optimizing preoperative nutrition and rigorously managing postoperative infections to mitigate IH risk. The higher IH rate in our study compared to some others may be attributed to differences in patient populations, surgical techniques, or postoperative care. Our cohort included a high proportion of patients undergoing surgery for trauma and peritonitis, which were identified as significant risk factors for IH. 19 This highlights the increased susceptibility of certain patient populations to IH development. Our binary regression analysis identified postoperative wound dehiscence and poor nutritional status as the only independent risk factors for IH development. This highlights the critical importance of preventing wound complications and ensuring adequate nutrition in the perioperative period to mitigate the risk of IH. These findings are consistent with previous studies demonstrating the strong association between wound-related complications and the incidence of IH. 8 , 14 , 15 , 22 , 34 Similarly, malnutrition has been recognized as a risk factor for IH in the literature. 11 , 18 , 23 , 31 Interestingly, although factors such as ASA grade, smoking, diabetes, hypertension, trauma, and peritonitis were significantly associated with IH in our univariate analysis, they did not emerge as independent risk factors in the multivariate model. This suggests that the impact of these factors on the development of IH may be mediated by their influence on wound healing and nutritional status. Further research is needed to elucidate the complex interplay between these risk factors and the occurrence of IH. The findings of our study underscore the importance of targeted interventions to prevent wound dehiscence and promote optimal nutrition in high-risk patients undergoing abdominal surgery. By addressing these modifiable risk factors, surgeons can reduce the incidence of IH and improve patient outcomes. Several factors that have been reported as risk factors for incisional hernia (IH) in previous studies did not emerge as significant in our analysis. These include age, sex, body mass index (BMI) and surgical variables such as operative approach (emergency vs. elective), specific procedure type, intraoperative blood transfusion, wound length, closure technique, type of incision, and wound classification. The lack of association between these factors and the risk of IH in our study may be due to differences in the characteristics of the patient population, surgical techniques, and postoperative care compared to other studies. For example, our cohort had a high proportion of young to middle-aged men undergoing surgery for trauma and peritonitis, which may have obscured any potential effects of age and sex on the risk of IH. Similarly, the uniformity of the surgical techniques and closure methods used in our study may have minimized their impact on the development of IH.IH development. Further research is needed to fully elucidate the influence of these factors on IH risk in different patient and surgical contexts. Despite the lack of significance in our study, previously reported associations between these factors and the risk of IH underscore the importance of considering all potential risk factors in patient assessment and surgical planning. Age, for example, has been linked to the risk of IH in some studies, and older patients may have impaired wound healing capacity. 9 , 13 , 17 , 31 Similarly, obesity has been identified as a risk factor for IH in several investigations. 14 , 33 , 35 – 38 Although our study did not find a significant impact of BMI on IH risk, this may be due to the relatively low proportion of obese patients in our cohort. Surgeons should remain aware of these potential risk factors and take steps to optimize patient conditions and surgical techniques accordingly to minimize the risk of IH. Prospective studies with larger and more diverse patient populations are warranted to further clarify the impact of these factors on the development of IH. Our study provides valuable information on the prevalence, timing, and risk factors of incisional hernia (IH) after abdominal surgery. The findings underscore the importance of identifying and modifying risk factors in the preoperative and postoperative periods to prevent the occurrence of IH. Identifying postoperative wound dehiscence and poor nutritional status as independent risk factors highlights the critical role of wound healing and nutrition in prevention of IH. While our study did not find associations between IH risk and certain factors identified as significant in previous research, these factors remain important considerations in patient assessment and surgical planning. More prospective studies with larger and more diverse patient populations are needed to fully elucidate the complex interplay of risk factors that influence the development of IH. By improving our understanding of IH risk factors and implementing targeted preventive strategies, surgeons can reduce the incidence of this common and morbid complication and improve patient outcomes. The limitations of our study include its retrospective design, which may introduce biases and limitations in data collection and analysis. Variable durations of follow-up may underestimate the true incidence of incisional hernia (IH), and the observed prevalence of IH may not be directly comparable to other studies due to variations in patient populations and surgical practices. The study findings are limited to the specific patient cohort, potentially restricting generalizability. Furthermore, the study's ability to establish causal relationships between identified risk factors and the development of IH is limited. Additional unmeasured confounding factors and the uniformity of the surgical techniques used in the study may also affect the interpretation of the results. Future prospective studies with standardized follow-up periods are necessary to fully capture the incidence of IH over time. Additionally, research is warranted investigating the impact of specific surgical techniques and closure methods on the development of IH. Conclusion In our study, we found a higher prevalence of IH compared to other studies and identified several risk factors, including ASA grade, smoking, diabetes, hypertension, malnutrition, trauma, peritonitis, SSI, and wound dehiscence. Wound dehiscence and poor nutritional status emerged as independent risk factors for IH development. Optimizing preoperative nutrition, managing postoperative infections, and preventing wound complications to reduce the risk of IH are crucial. More research is needed to explore the complex relationships between these factors and the occurrence of IH, ultimately leading to targeted interventions that can improve patient outcomes. Declarations Acknowledgments Not applicable. Ethical Considerations The study received ethical approval from the Ethical Committee of Sana'a University. Furthermore, administrative consent was obtained from both the 48 Model Hospital and the Military General Hospital to access the medical records of the patients involved in the study. Written consent was obtained from all participants. Additionally, we strictly followed the principles outlined in the Declaration of Helsinki throughout the entire study process. Disclosure The authors report no conflicts of interest. Conflicts of interest Non-financial competing interests Funding Disclosure This study did not receive specific grants from funding agencies in the public, commercial or non-profit sectors. Data availability The data sets used and/or analyzed during the current study are available from the corresponding author upon reasonable request. References Cassar K, Munro A (2002) Surgical treatment of incisional hernia. Br J Surg 89(5):534–545. 10.1046/j.1365-2168.2002.02083.x Hope WW, Tuma F, Incisional Hernia. StatPearls Publishing LLC (2024) Accessed April 14, 2024. https://www.ncbi.nlm.nih.gov/books/NBK435995/ Santora TA, Roslyn JJ, Incisional, Hernia (1993) Surg Clin North Am 73(3):557–570. 10.1016/S0039-6109(16)46037-8 Kaneko T, Funahashi K, Ushigome M et al (2019) Incidence of and risk factors for incisional hernia after closure of temporary ileostomy for colorectal malignancy. Hernia 23(4):743–748. 10.1007/s10029-018-1855-4 Blatnik JA, Michael Brunt L (2019) Controversies and Techniques in the Repair of Abdominal Wall Hernias. J Gastrointest Surg 23(4):837–845. 10.1007/s11605-018-3989-1 Burger JWA, Lange JF, Halm JA, Kleinrensink G, Jeekel H (2005) Incisional Hernia: Early Complication of Abdominal Surgery. World J Surg 29(12):1608–1613. 10.1007/s00268-005-7929-3 Kössler-Ebs JB, Grummich K, Jensen K et al (2016) Incisional Hernia Rates After Laparoscopic or Open Abdominal Surgery—A Systematic Review and Meta‐Analysis. World J Surg 40(10):2319–2330. 10.1007/s00268-016-3520-3 Itatsu K, Yokoyama Y, Sugawara G et al (2014) Incidence of and risk factors for incisional hernia after abdominal surgery. Br J Surg 101(11):1439–1447. 10.1002/bjs.9600 Sørensen LT (2005) Smoking Is a Risk Factor for Incisional Hernia. Arch Surg 140(2):119. 10.1001/archsurg.140.2.119 Le Huu Nho R, Mege D, Ouaïssi M, Sielezneff I, Sastre B (2012) Incidence and prevention of ventral incisional hernia. J Visc Surg 149(5):e3–e14. 10.1016/j.jviscsurg.2012.05.004 Caglià P, Tracia A, Borzì L et al (2014) Incisional hernia in the elderly: Risk factors and clinical considerations. Int J Surg 12:S164–S169. 10.1016/j.ijsu.2014.08.357 Bhangu A, Nepogodiev D, Futaba K (2012) Systematic Review and Meta-analysis of the Incidence of Incisional Hernia at the Site of Stoma Closure. World J Surg 36(5):973–983. 10.1007/s00268-012-1474-7 Yahchouchy-Chouillard E, Aura T, Picone O, Etienne JC, Fingerhut A (2003) Incisional Hernias. Dig Surg 20(1):3–9. 10.1159/000068850 Heimann TM, Swaminathan S, Greenstein AJ, Steinhagen RM (2018) Incidence and Factors Correlating With Incisional Hernia Following Open Bowel Resection in Patients With Inflammatory Bowel Disease. Ann Surg 267(3):532–536. 10.1097/SLA.0000000000002120 Leitman IM, Horowitz ML (2008) Risk Factors for the Development of Incisional Hernia Following Roux-en- Y Gastric Bypass Surgery. Open Surg J 2(1):15–17. 10.2174/1874300500802010015 Chavan SG, Nithin SN, Jaiswal K, Rambatla M (2020) Incidence of incisional hernia with respect to different sites and causes. Int Surg J 7(8):2539. 10.18203/2349-2902.isj20203231 Bosanquet DC, Ansell J, Abdelrahman T et al (2015) Systematic Review and Meta-Regression of Factors Affecting Midline Incisional Hernia Rates: Analysis of 14 618 Patients. PLoS ONE 10(9):e0138745. 10.1371/journal.pone.0138745 Yilmaz KB, Akinci M, Dogan L, Kahraman N, Ozaslan C, Atalay C (2013) A prospective evaluation of the risk factors for wound dehiscence and incisional hernia development. Turk J Surg Published online April 24. 10.5152/UCD.2013.06 Mir SA, Akram W, Gilkar IA, Bali RS, Mughal JI (2020) Short Term Incidence of Incisional Hernia after Emergency Midline Laparotomy. J Evid Based Med Healthc 7(12):591–595. 10.18410/jebmh/2020/130 Dai W, Chen Z, Zuo J, Tan J, Tan M, Yuan Y (2019) Risk factors of postoperative complications after emergency repair of incarcerated groin hernia for adult patients: a retrospective cohort study. Hernia 23(2):267–276. 10.1007/s10029-018-1854-5 Fischer JP, Basta MN, Mirzabeigi MN et al (2016) A Risk Model and Cost Analysis of Incisional Hernia After Elective, Abdominal Surgery Based Upon 12,373 Cases. Ann Surg 263(5):1010–1017. 10.1097/SLA.0000000000001394 Song IH, Ha HK, Choi SG, Jeon BG, Kim MJ, Park KJ (2012) Analysis of Risk Factors for the Development of Incisional and Parastomal Hernias in Patients after Colorectal Surgery. J Korean Soc Coloproctol 28(6):299. 10.3393/jksc.2012.28.6.299 Ahn BK (2012) Risk Factors for Incisional Hernia and Parastomal Hernia after Colorectal Surgery. J Korean Soc Coloproctol 28(6):280. 10.3393/jksc.2012.28.6.280 Söderbäck H, Gunnarsson U, Hellman P, Sandblom G (2018) Incisional hernia after surgery for colorectal cancer: a population-based register study. Int J Colorectal Dis 33(10):1411–1417. 10.1007/s00384-018-3124-5 Hodgson NCF, Malthaner RA, Østbye T (2000) The Search for an Ideal Method of Abdominal Fascial Closure. Ann Surg 231(3):436–442. 10.1097/00000658-200003000-00018 Deerenberg EB, Henriksen NA, Antoniou GA et al (2022) Updated guideline for closure of abdominal wall incisions from the European and American Hernia Societies. Br J Surg 109(12):1239–1250. 10.1093/bjs/znac302 Muysoms FE, Deerenberg EB, Peeters E et al (2013) Recommendations for reporting outcome results in abdominal wall repair. Hernia 17(4):423–433. 10.1007/s10029-013-1108-5 Berríos-Torres SI, Umscheid CA, Bratzler DW et al (2017) Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017. JAMA Surg 152(8):784. 10.1001/jamasurg.2017.0904 Fink C, Baumann P, Wente MN et al (2013) Incisional hernia rate 3 years after midline laparotomy. Br J Surg 101(2):51–54. 10.1002/bjs.9364 Eeftinck Schattenkerk LD, Musters GD, Coultre SE, de Le WJ, van Heurn LE, Derikx JPM (2021) Incisional hernia after abdominal surgery in infants: A retrospective analysis of incidence and risk factors. J Pediatr Surg 56(11):2107–2112. 10.1016/j.jpedsurg.2021.01.037 Spencer RJ, Hayes KD, Rose S et al (2015) Risk Factors for Early-Occurring and Late-Occurring Incisional Hernias After Primary Laparotomy for Ovarian Cancer. Obstet Gynecol 125(2):407–413. 10.1097/AOG.0000000000000610 Jargon D, Friebe V, Hopt U, Obermaier R (2008) Risikoprofil und Rezidivprophylaxe der Narbenhernie – was ist evidenzbasiert? Zentralbl Chir 133(05):453–457. 10.1055/s-2008-1076961 Jang EJ, Kim MC, Nam SH (2018) Risk Factors for the Development of Incisional Hernia in Mini-laparotomy Wounds Following Laparoscopic Distal Gastrectomy in Patients with Gastric Cancer. J Gastric Cancer 18(4):392. 10.5230/jgc.2018.18.e39 Ulukent SC, Erdem B, Seyhan NA, Canaz E, Sahbaz NA, Akbayir O (2016) Management of Enteroatmospheric Fistulae Developing Post Sitoreductive Surgery. J Acad Res Med 6(2):122–125. 10.5152/jarem.2016.929 Sayur V, Güler E, Posacioglu H, Sezer TO, Fırat Ö, Ersin MS (2021) Incidence and risk factors for incisional hernia after abdominal aortic aneurysm and aortic occlusive disease surgery. Turkish J Thorac Cardiovasc Surg 29:465–470. https://api.semanticscholar.org/CorpusID:240148825 Höer J, Lawong G, Klinge U, Schumpelick V (2002) Einflussfaktoren der Narbenhernienentstehung Retrospektive Untersuchung an 2.983 laparotomierten Patienten über einen Zeitraum von 10 Jahren. Chirurg 73(5):474–480. 10.1007/s00104-002-0425-5 de Alhambra-Rodríguez C, Morandeira-Rivas AJ, Herrero-Bogajo ML, Moreno-Sanz C (2020) Incidence and Risk Factors of Incisional Hernia After Single-Incision Endoscopic Surgery. J Laparoendosc Adv Surg Tech 30(3):251–255. 10.1089/lap.2019.0728 Yamamoto M, Takakura Y, Ikeda S, Itamoto T, Urushihara T, Egi H (2018) Visceral obesity is a significant risk factor for incisional hernia after laparoscopic colorectal surgery: A single-center review. Asian J Endosc Surg 11(4):373–377. 10.1111/ases.12466 Additional Declarations The authors declare no competing interests. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4889078","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":338327197,"identity":"50d2f356-6ba4-423a-a729-a5f86fe00889","order_by":0,"name":"Mohammed Ali Issa","email":"","orcid":"","institution":"Department of Surgery, Faculty of Medicine and Health Sciences, Sana’a University, Sana’a City, Yemen","correspondingAuthor":false,"prefix":"","firstName":"Mohammed","middleName":"Ali","lastName":"Issa","suffix":""},{"id":338327198,"identity":"6128c71f-ac52-47fe-8f23-aa9436b381db","order_by":1,"name":"Ali Lotf Al-Amry","email":"","orcid":"https://orcid.org/0009-0000-8627-3939","institution":"Department of Surgery, Faculty of Medicine and Health Sciences, Sana’a University, Sana’a City, Yemen","correspondingAuthor":false,"prefix":"","firstName":"Ali","middleName":"Lotf","lastName":"Al-Amry","suffix":""},{"id":338327199,"identity":"8447d5bc-f460-4228-ad6d-61ed1a0bbf2c","order_by":2,"name":"Yasser Abdurabo Obadiel","email":"","orcid":"https://orcid.org/0000-0002-3566-7281","institution":"Department of Surgery, Faculty of Medicine and Health Sciences, Sana’a University, Sana’a, Yemen; 2Department of Surgery, Military General Hospital, Sana’a City, Yemen","correspondingAuthor":false,"prefix":"","firstName":"Yasser","middleName":"Abdurabo","lastName":"Obadiel","suffix":""},{"id":338327200,"identity":"ad9918b1-f344-47d0-8d1d-2c8d2cb26c78","order_by":3,"name":"Eissa Ali Al-Jabri","email":"","orcid":"","institution":"Department of Surgery, 48 Model Hospital, Sana’a City, Yemen.","correspondingAuthor":false,"prefix":"","firstName":"Eissa","middleName":"Ali","lastName":"Al-Jabri","suffix":""},{"id":338327201,"identity":"230d706a-8ae8-4f56-a870-bd2d07db20b3","order_by":4,"name":"Haitham Mohammed Jowah","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzUlEQVRIiWNgGAWjYBACAwaGBCB1QA7M4yFFizFJWkDgQGID0VrMGRgePuapuZM+f0YC44O3bQyJ/YS0WDYwJBvzHHuWu+FGArPhXKCWmQ2EHHaAIU06h+1w7gaJBDZpXqCWDQeI0vLvcLr8jAT23yAt+4nSktt2OIHhRgIbM9gWQn4xOAz0y9++w4YbzjxslpxzTsJ4BkFbjvckPpzx7bC8fHvywQ9vymxk+xsIWcPMkwBlMYLUSjgS1MHAwI7qEHvCOkbBKBgFo2CkAQCEAUMIrb03fgAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0009-0008-3815-3017","institution":"Department of Surgery, Faculty of Medicine and Health Sciences, Sana’a University, Sana’a City, Yemen","correspondingAuthor":true,"prefix":"","firstName":"Haitham","middleName":"Mohammed","lastName":"Jowah","suffix":""}],"badges":[],"createdAt":"2024-08-09 21:06:10","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-4889078/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4889078/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":62530342,"identity":"eb46d847-a28e-44b7-bd1e-4f9ab13113b4","added_by":"auto","created_at":"2024-08-15 12:17:27","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":66782,"visible":true,"origin":"","legend":"\u003cp\u003ePrevalence of Incisional Hernia among Study population\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-4889078/v1/3796584d35e5b27d03b1033d.png"},{"id":62530878,"identity":"70aef972-29dc-4331-b0e7-33ab51e28bf5","added_by":"auto","created_at":"2024-08-15 12:25:28","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":693868,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4889078/v1/8dfad81a-598c-4a2c-b238-3abfb0e5da04.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003ePrevalence and Risk Factors of Incisional Hernia Following Abdominal Surgery Among Yemeni Patients: A Retrospective Study\u003c/p\u003e","fulltext":[{"header":"Plain Language Summary","content":"\u003cp\u003eThis study aimed to understand how often incisional hernias (IH) occur after abdominal surgery in high-risk patients and identify factors that increase the risk of developing an IH. Researchers reviewed the records of 222 patients who had abdominal surgery in Yemen. They collected information on patient characteristics, surgical details, and postoperative outcomes. The study found that 19% of patients experienced an IH, with more than half of them developing it within a year after surgery (around 11 months on average). Several factors increased the risk of IH, including preoperative health status, smoking, diabetes, high blood pressure, inadequate nutrient intake, traumatic injury, infection of the abdominal cavity lining, wound infection, and wound opening. The most closely linked factors to IH were wound opening and inadequate nutrient intake. These findings highlight the importance of ensuring patients are well-nourished before surgery, preventing postoperative infections, and promoting proper wound healing to reduce the risk of IH. Further research is needed to better understand how these factors interact and improve patient outcomes.\u003c/p\u003e"},{"header":"Introduction","content":"\u003cp\u003eIncisional hernia is a frequent and a common complication of abdominal surgery and can lead to significant morbidity, such as intestinal obstruction or strangulation, and increased healthcare costs.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e It represents a breakdown or loss of continuity of fascial closure, and they are unique in that they are the only abdominal wall hernias that are considered iatrogenic.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e The pathogenesis of incisional hernias is complex and involves factors such as type of abdominal surgery, patient characteristics, and surgical techniques.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eSeveral studies have explored the incidence and risk factors for IH after abdominal surgery, with incidence rates after midline laparotomy ranging from 11\u0026ndash;20%.\u003csup\u003e6\u003c/sup\u003e Furthermore, a systematic review and meta-analysis found that the incidence of incisional hernias ranged from 4.3% in the laparoscopic surgical approach to 10.1% in the open surgical approach, with a significant reduction in IH rate among laparoscopic approach.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e Another study provided a more comprehensive understanding of long-term risk by estimating the incidence rates of incisional hernias at 12 and 24 months after surgery, which were 5.2% and 10.5%, respectively.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe risk factors for incisional hernias are multifaceted as the occurrence of IH depends on the presence of various risk factors, including patient-related factors (advanced age, sex, BMI, smoking history, chronic diseases),\u003csup\u003e\u003cspan additionalcitationids=\"CR10 CR11 CR12 CR13 CR14\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e disease-related factors (midline incisions, emergency surgery, stoma formation, wound infections),\u003csup\u003e\u003cspan additionalcitationids=\"CR17 CR18 CR19 CR20 CR21 CR22\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e and technical factors (poor surgical techniques, suture material).\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e,\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003ePrevention involves meticulous abdominal wall closure techniques, such as continuous non-absorbable sutures, mesh reinforcement, and tension-free closure.\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e,\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e Additional strategies include optimal nutrition, smoking cessation, and managing underlying medical conditions. Continuous follow-up and adherence to preventive measures are essential to reduce the incidence of IHs.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIncisional hernias after abdominal surgery and their prevalence and risk factors in resource-limited settings remain poorly understood. Developing countries, such as our country, Yemen, face unique challenges in healthcare infrastructure, limited resources, and surgical practices, which can influence the incidence and characteristics of incisional hernias. The lack of previous studies on the prevalence and risk factors specific to these settings hinders the development of effective preventive strategies and optimized surgical care. Therefore, this study was of great importance to investigate the prevalence and risk factors associated with incisional hernias after abdominal surgery in resource-limited settings, with the objective of filling this knowledge gap and inform evidence-based practices for better patient care and outcomes.\u003c/p\u003e"},{"header":"Material and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Setting:\u003c/h2\u003e \u003cp\u003eThis was a retrospective cross-sectional study conducted at two hospitals in Yemen. We reviewed the medical records of patients who underwent abdominal surgery at these institutions over a period of 3 years ( 2019 to 2021). The study is reported according to the Incisional Hernia Reporting Guidelines to facilitate comparison with other research in this field.\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003ePatient Population:\u003c/h2\u003e \u003cp\u003eThe study included all patients who underwent abdominal surgery during the study period and had at least 6 months of postoperative follow-up. Patients who died within 30 days after surgery or had incomplete medical records were excluded.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eData Collection:\u003c/h2\u003e \u003cp\u003eData were collected from medical records by trained abstractors using a standardized data collection form based on previous studies. Demographic data included age, sex, body mass index (BMI), physical status classification of the American Society of Anesthesiologists (ASA), and comorbidities. Surgical data included indication for surgery, type of procedure, operative approach (emergency vs. elective), specific procedure performed, intraoperative blood transfusion, wound length, closure technique, type of incision, and wound classification. Postoperative data included the occurrence of surgical site infection (SSI), wound dehiscence, and incisional hernia (IH). The timing of the IH occurrence was also recorded.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eDefinitions:\u003c/h2\u003e \u003cp\u003eIH was defined as a protrusion of abdominal contents through the fascial defect at the site of the previous surgical incision. The diagnosis of IH was based on clinical examination by the surgical team and was confirmed by radiographic imaging in some cases. Surgical site infection was defined according to the Centers for Disease Control and Prevention (CDC) criteria.\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e Wound dehiscence was defined as the separation of the sutured edges of the abdominal fascia after surgery developed on days 3\u0026ndash;7 postoperatively, regardless of the need for reoperation. Poor nutrition status was defined as serum albumin level\u0026thinsp;\u0026lt;\u0026thinsp;3.5mg/dl.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eFollow-up:\u003c/h2\u003e \u003cp\u003eThe follow-up period was defined as the time from surgery to the last clinical follow-up or the diagnosis of IH, whichever occurred first. The time of IH occurrence was recorded as the interval from surgery to the diagnosis of IH.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis:\u003c/h2\u003e \u003cp\u003eUnivariate analysis was performed to identify potential risk factors for IH. Categorical variables were compared using the chi-square test or Fisher's exact test as appropriate. Continuous variables were compared using Student's t test or Mann-Whitney U test, as appropriate. Variables with a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 on univariate analysis were entered into a multivariate logistic regression model to identify independent risk factors for IH. Odds ratios (OR) with 95% confidence intervals (CI) were calculated. A p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eDuring our study, a total of 300 potential eligible cases were collected from the surgical departments of 48 Modern Hospital and Military Hospital in Sana'a city, Yemen, during the study period. However, 78 patients were excluded due to incomplete medical records, which resulted in 222 eligible cases being included in the study. Data from these 222 patients were reviewed and analyzed, revealing the following findings:\u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eDemographic characteristics\u003c/h2\u003e \u003cp\u003eMost of the patients were men (84.7%, n\u0026thinsp;=\u0026thinsp;188), with women comprising 15.3% (n\u0026thinsp;=\u0026thinsp;34). The predominant age range was 21\u0026ndash;40 years, comprising 64% (n\u0026thinsp;=\u0026thinsp;143) of the cases, followed by those 41\u0026ndash;60 years with 23% (n\u0026thinsp;=\u0026thinsp;51). Regarding BMI, 68.9% had normal weight, 27% were overweight and 4.1% were obese. Regarding the grades of the American Society of Anesthesiologists (ASA), 51.8% were classified as grade I, 40.1% as grade II, and 8.1% as grade III. The leading comorbidities included smoking (27.9%), hypertension (19.8%), diabetes mellitus (9.5%), chronic pulmonary disease (8.1%), poor nutritional status (3.6%) and a history of preoperative chemotherapy or radiation therapy (1.8%). Abdominal surgery was performed for various indications in the studied population. The most common indication was trauma, accounting for 53.6% of the cases, followed by peritonitis at 21.6% and intestinal obstruction at 9.5%. GI tumors and hepatobiliary disorders each represented 4.5% of the indications, while gynecological disorders accounted for 2.7%. Urological disorders were observed in 1.8% of the cases and the remaining 0.9% were classified as other indications \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic Characteristics of the study population\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e188\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge groups\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e21\u0026ndash;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e143\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e41\u0026ndash;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eComorbidities\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes millets\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChronic obstructive pulmonary disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChronic liver disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative chemotherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor nutritional status (albumin level\u0026thinsp;\u0026lt;\u0026thinsp;3.5 mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBody mass index\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;25 kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e153\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25 kg/m\u0026sup2; \u0026minus;\u0026thinsp;29.9 kg/m\u0026sup2;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;30kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eASA grade\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIndications for abdominal surgery\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrauma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e119\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeritonitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntestinal obstruction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGI tumors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHepato-biliary disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGynecology disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrology disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003e\u003cem\u003eASA: American Society of Anesthesiologists\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003ePrevalence of IH\u003c/h2\u003e \u003cp\u003eThe prevalence of incisional hernia (IH) after abdominal surgery among the study population was 19%, with 42 out of 222 patients developed IH postoperatively \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eRisk Factors for IH\u003c/h2\u003e \u003cp\u003eThe univariate analysis of perioperative risk factors for incisional hernia (IH) revealed several significant associations (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Patients with higher ASA grades (II and III) had a significantly increased risk of IH (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Comorbidities such as smoking (p\u0026thinsp;=\u0026thinsp;0.044), diabetes mellitus (DM) (p\u0026thinsp;=\u0026thinsp;0.003), hypertension (HTN) (p\u0026thinsp;=\u0026thinsp;0.044) and poor nutritional status (p\u0026thinsp;=\u0026thinsp;0.022) were also significantly associated with a higher probability of IH. Trauma (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and peritonitis (p\u0026thinsp;=\u0026thinsp;0.001) were identified as significant indications for surgery that were strongly associated with IH. Furthermore, postoperative complications, including surgical site infection (p\u0026thinsp;=\u0026thinsp;0.015) and wound dehiscence (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), showed a significant association with IH \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e. However, a binary regression test revealed that postoperative dehiscence emerged as a highly significant risk factor (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) with an estimated odds ratio of 9.874 (95% CI: 3.317\u0026ndash;29.389), indicating a substantial increase in IH risk for patients experiencing wound dehiscence. Poor nutritional status also showed a significant association (p\u0026thinsp;=\u0026thinsp;0.009) with an odds ratio of 9.899 (95% CI: 1.777\u0026ndash;55.161), indicating that patients with inadequate nutrition had a significantly higher probability of developing IH \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnivariate Analysis of Perioperative Risk Factors for Incisional Hernia\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRisk factors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eIncisional Hernia\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003ep- value\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePatient with\u003c/p\u003e \u003cp\u003eNo.= 42\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePatient without\u003c/p\u003e \u003cp\u003eNo.= 180\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo.= 222\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eASA grade\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (26.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e104 (57.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e115 (51.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003e.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23 (54.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66 (36.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e89 (40.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (19%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (5.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18 (8.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eComorbidities\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17 (40.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e62(27.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e.044*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (21.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (6.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e21(9.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e.003*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHTN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (31%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31 (17.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e44(19.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e.044*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003epoor nutritional status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (9.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (2.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8 (3. %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e.022*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIndication for surgery\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrauma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (28.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e109 (60.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e121(54.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeritonitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17 (40.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31 (17.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e48(21.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePostoperative complications\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical site infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24 (57.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57 (31.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e81 (36. %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e.015*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWound dehiscence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (47.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (12.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e42 (18.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cem\u003e* significant p- value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 by chi-square test\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBinary logistic regression analysis of perioperative risk factors for incisional hernia\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRisk factors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eIncisional Hernia\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eP value\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eOdd ration\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePatient with\u003c/p\u003e \u003cp\u003eno\u0026thinsp;=\u0026thinsp;42\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePatient without\u003c/p\u003e \u003cp\u003eno\u0026thinsp;=\u0026thinsp;180\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eno\u0026thinsp;=\u0026thinsp;222\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003eUpper\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003eLower\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWound dehiscence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20 (47.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22 (12.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e42(18.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e9.874\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e3.317\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e29.389\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor nutrition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4 (9.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 (2.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8 (3. %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e.009*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e9.899\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.777\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e55.161\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003cem\u003e* significant p- value\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn this study, age, sex, and BMI did not show a significant association with the occurrence of IH. Furthermore, emergency operations were more common (85.6%) compared to elective operations (14.4%), but there was no significant difference in the occurrence of incisional hernia (IH) based on the surgical approach (P\u0026thinsp;=\u0026thinsp;0.118). The most common operative procedure was small intestine (40.5%), followed by large intestine (34.7%) and hepato-biliary procedures (7.7%), without significant association with IH (P\u0026thinsp;=\u0026thinsp;0.360). Intraoperative blood transfusion and wound length also did not show significant associations with IH (P\u0026thinsp;=\u0026thinsp;0.564, P\u0026thinsp;=\u0026thinsp;0.389, respectively). The continuous non-absorbable fascial closure technique was used most frequently (66.7%), but there were no significant differences in IH rates between closure techniques (P\u0026thinsp;=\u0026thinsp;0.377). Most cases had midline incisions (82.9%) and class II wound classification (42.3%), but neither the type of incision nor the class of wound class showed significant associations with IH (P\u0026thinsp;=\u0026thinsp;0.936, P\u0026thinsp;=\u0026thinsp;0.787, respectively).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eThe prevalence of IH in relation to the timing of its occurrence\u003c/h2\u003e \u003cp\u003eThe prevalence of incisional hernia (IH) in relation to the time of its development after surgery was examined. Among the patients who developed IH postoperatively, 57.1% (24 patients) experienced IH within the first year, resulting in a prevalence rate of 10.8%. In the second year, 28.6% (12 patients) developed IH, with a prevalence rate of 5.4%, followed by 14.3% (6 patients) in the third year, with a prevalence rate of 2.7%. The median time to develop IH after surgery was 11 months, ranging from 9 to 24 months \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of prevalence rate of Incisional Hernia in relation to time of its occurrence\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYears\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo. of patient\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eValid percentage\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePrevalence rate\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1st year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e57.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2nd year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3rd year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e42\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e100.0\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e18.9\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur study provides a comprehensive examination of the prevalence, timing, and risk factors of incisional hernia (IH) after abdominal surgery. The overall prevalence of IH of 19% is higher than reported in some studies.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e but comparable to others.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e,\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e The early onset of IH in our study, with 57% of cases occurring within 1 year, aligns with the findings that the incidence of IH increases over time.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e This highlights the importance of prolonged postoperative surveillance for the detection of IH.\u003c/p\u003e \u003cp\u003eOur identified risk factors, including ASA grade, smoking, diabetes, hypertension, malnutrition, trauma, peritonitis, surgical site infection (SSI), and wound dehiscence, overlap with those in the literature.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e,\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e,\u003cspan additionalcitationids=\"CR32\" citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e Smoking has been established as a risk factor for IH \u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e, and our study confirms this association. Similarly, diabetes and hypertension have been linked to IH in previous research.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e The significant impact of nutritional status and infectious complications on IH development in our study underscores the importance of optimizing preoperative nutrition and rigorously managing postoperative infections to mitigate IH risk.\u003c/p\u003e \u003cp\u003eThe higher IH rate in our study compared to some others may be attributed to differences in patient populations, surgical techniques, or postoperative care. Our cohort included a high proportion of patients undergoing surgery for trauma and peritonitis, which were identified as significant risk factors for IH.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e This highlights the increased susceptibility of certain patient populations to IH development.\u003c/p\u003e \u003cp\u003eOur binary regression analysis identified postoperative wound dehiscence and poor nutritional status as the only independent risk factors for IH development. This highlights the critical importance of preventing wound complications and ensuring adequate nutrition in the perioperative period to mitigate the risk of IH. These findings are consistent with previous studies demonstrating the strong association between wound-related complications and the incidence of IH. \u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e,\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e,\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e Similarly, malnutrition has been recognized as a risk factor for IH in the literature.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e,\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e,\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eInterestingly, although factors such as ASA grade, smoking, diabetes, hypertension, trauma, and peritonitis were significantly associated with IH in our univariate analysis, they did not emerge as independent risk factors in the multivariate model. This suggests that the impact of these factors on the development of IH may be mediated by their influence on wound healing and nutritional status. Further research is needed to elucidate the complex interplay between these risk factors and the occurrence of IH. The findings of our study underscore the importance of targeted interventions to prevent wound dehiscence and promote optimal nutrition in high-risk patients undergoing abdominal surgery. By addressing these modifiable risk factors, surgeons can reduce the incidence of IH and improve patient outcomes.\u003c/p\u003e \u003cp\u003eSeveral factors that have been reported as risk factors for incisional hernia (IH) in previous studies did not emerge as significant in our analysis. These include age, sex, body mass index (BMI) and surgical variables such as operative approach (emergency vs. elective), specific procedure type, intraoperative blood transfusion, wound length, closure technique, type of incision, and wound classification. The lack of association between these factors and the risk of IH in our study may be due to differences in the characteristics of the patient population, surgical techniques, and postoperative care compared to other studies. For example, our cohort had a high proportion of young to middle-aged men undergoing surgery for trauma and peritonitis, which may have obscured any potential effects of age and sex on the risk of IH. Similarly, the uniformity of the surgical techniques and closure methods used in our study may have minimized their impact on the development of IH.IH development. Further research is needed to fully elucidate the influence of these factors on IH risk in different patient and surgical contexts.\u003c/p\u003e \u003cp\u003eDespite the lack of significance in our study, previously reported associations between these factors and the risk of IH underscore the importance of considering all potential risk factors in patient assessment and surgical planning. Age, for example, has been linked to the risk of IH in some studies, and older patients may have impaired wound healing capacity.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e,\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e Similarly, obesity has been identified as a risk factor for IH in several investigations.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e,\u003cspan additionalcitationids=\"CR36 CR37\" citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e Although our study did not find a significant impact of BMI on IH risk, this may be due to the relatively low proportion of obese patients in our cohort. Surgeons should remain aware of these potential risk factors and take steps to optimize patient conditions and surgical techniques accordingly to minimize the risk of IH. Prospective studies with larger and more diverse patient populations are warranted to further clarify the impact of these factors on the development of IH.\u003c/p\u003e \u003cp\u003eOur study provides valuable information on the prevalence, timing, and risk factors of incisional hernia (IH) after abdominal surgery. The findings underscore the importance of identifying and modifying risk factors in the preoperative and postoperative periods to prevent the occurrence of IH. Identifying postoperative wound dehiscence and poor nutritional status as independent risk factors highlights the critical role of wound healing and nutrition in prevention of IH. While our study did not find associations between IH risk and certain factors identified as significant in previous research, these factors remain important considerations in patient assessment and surgical planning. More prospective studies with larger and more diverse patient populations are needed to fully elucidate the complex interplay of risk factors that influence the development of IH. By improving our understanding of IH risk factors and implementing targeted preventive strategies, surgeons can reduce the incidence of this common and morbid complication and improve patient outcomes.\u003c/p\u003e \u003cp\u003eThe limitations of our study include its retrospective design, which may introduce biases and limitations in data collection and analysis. Variable durations of follow-up may underestimate the true incidence of incisional hernia (IH), and the observed prevalence of IH may not be directly comparable to other studies due to variations in patient populations and surgical practices. The study findings are limited to the specific patient cohort, potentially restricting generalizability. Furthermore, the study's ability to establish causal relationships between identified risk factors and the development of IH is limited. Additional unmeasured confounding factors and the uniformity of the surgical techniques used in the study may also affect the interpretation of the results.\u003c/p\u003e \u003cp\u003eFuture prospective studies with standardized follow-up periods are necessary to fully capture the incidence of IH over time. Additionally, research is warranted investigating the impact of specific surgical techniques and closure methods on the development of IH.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn our study, we found a higher prevalence of IH compared to other studies and identified several risk factors, including ASA grade, smoking, diabetes, hypertension, malnutrition, trauma, peritonitis, SSI, and wound dehiscence. Wound dehiscence and poor nutritional status emerged as independent risk factors for IH development. Optimizing preoperative nutrition, managing postoperative infections, and preventing wound complications to reduce the risk of IH are crucial. More research is needed to explore the complex relationships between these factors and the occurrence of IH, ultimately leading to targeted interventions that can improve patient outcomes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eAcknowledgments\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003eEthical Considerations\u003c/p\u003e\n\u003cp\u003eThe study received ethical approval from the Ethical Committee of Sana\u0026apos;a University. Furthermore, administrative consent was obtained from both the 48 Model Hospital and the Military General Hospital to access the medical records of the patients involved in the study. Written consent was obtained from all participants. Additionally, we strictly followed the principles outlined in the Declaration of Helsinki throughout the entire study process.\u003c/p\u003e\n\u003cp\u003eDisclosure\u003c/p\u003e\n\u003cp\u003eThe authors report no conflicts of interest.\u003c/p\u003e\n\u003cp\u003eConflicts of interest\u003c/p\u003e\n\u003cp\u003eNon-financial competing interests\u003c/p\u003e\n\u003cp\u003eFunding Disclosure\u003c/p\u003e\n\u003cp\u003eThis study did not receive specific grants from funding agencies in the public, commercial or non-profit sectors.\u003c/p\u003e\n\u003cp\u003eData availability\u003c/p\u003e\n\u003cp\u003eThe data sets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCassar K, Munro A (2002) Surgical treatment of incisional hernia. Br J Surg 89(5):534\u0026ndash;545. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1046/j.1365-2168.2002.02083.x\u003c/span\u003e\u003cspan address=\"10.1046/j.1365-2168.2002.02083.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHope WW, Tuma F, Incisional Hernia. StatPearls Publishing LLC (2024) Accessed April 14, 2024. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ncbi.nlm.nih.gov/books/NBK435995/\u003c/span\u003e\u003cspan address=\"https://www.ncbi.nlm.nih.gov/books/NBK435995/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSantora TA, Roslyn JJ, Incisional, Hernia (1993) Surg Clin North Am 73(3):557\u0026ndash;570. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S0039-6109(16)46037-8\u003c/span\u003e\u003cspan address=\"10.1016/S0039-6109(16)46037-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKaneko T, Funahashi K, Ushigome M et al (2019) Incidence of and risk factors for incisional hernia after closure of temporary ileostomy for colorectal malignancy. Hernia 23(4):743\u0026ndash;748. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s10029-018-1855-4\u003c/span\u003e\u003cspan address=\"10.1007/s10029-018-1855-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBlatnik JA, Michael Brunt L (2019) Controversies and Techniques in the Repair of Abdominal Wall Hernias. J Gastrointest Surg 23(4):837\u0026ndash;845. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s11605-018-3989-1\u003c/span\u003e\u003cspan address=\"10.1007/s11605-018-3989-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBurger JWA, Lange JF, Halm JA, Kleinrensink G, Jeekel H (2005) Incisional Hernia: Early Complication of Abdominal Surgery. World J Surg 29(12):1608\u0026ndash;1613. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00268-005-7929-3\u003c/span\u003e\u003cspan address=\"10.1007/s00268-005-7929-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eK\u0026ouml;ssler-Ebs JB, Grummich K, Jensen K et al (2016) Incisional Hernia Rates After Laparoscopic or Open Abdominal Surgery\u0026mdash;A Systematic Review and Meta‐Analysis. World J Surg 40(10):2319\u0026ndash;2330. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00268-016-3520-3\u003c/span\u003e\u003cspan address=\"10.1007/s00268-016-3520-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eItatsu K, Yokoyama Y, Sugawara G et al (2014) Incidence of and risk factors for incisional hernia after abdominal surgery. Br J Surg 101(11):1439\u0026ndash;1447. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/bjs.9600\u003c/span\u003e\u003cspan address=\"10.1002/bjs.9600\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eS\u0026oslash;rensen LT (2005) Smoking Is a Risk Factor for Incisional Hernia. Arch Surg 140(2):119. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1001/archsurg.140.2.119\u003c/span\u003e\u003cspan address=\"10.1001/archsurg.140.2.119\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLe Huu Nho R, Mege D, Oua\u0026iuml;ssi M, Sielezneff I, Sastre B (2012) Incidence and prevention of ventral incisional hernia. J Visc Surg 149(5):e3\u0026ndash;e14. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jviscsurg.2012.05.004\u003c/span\u003e\u003cspan address=\"10.1016/j.jviscsurg.2012.05.004\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCagli\u0026agrave; P, Tracia A, Borz\u0026igrave; L et al (2014) Incisional hernia in the elderly: Risk factors and clinical considerations. Int J Surg 12:S164\u0026ndash;S169. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ijsu.2014.08.357\u003c/span\u003e\u003cspan address=\"10.1016/j.ijsu.2014.08.357\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBhangu A, Nepogodiev D, Futaba K (2012) Systematic Review and Meta-analysis of the Incidence of Incisional Hernia at the Site of Stoma Closure. World J Surg 36(5):973\u0026ndash;983. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00268-012-1474-7\u003c/span\u003e\u003cspan address=\"10.1007/s00268-012-1474-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYahchouchy-Chouillard E, Aura T, Picone O, Etienne JC, Fingerhut A (2003) Incisional Hernias. Dig Surg 20(1):3\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1159/000068850\u003c/span\u003e\u003cspan address=\"10.1159/000068850\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHeimann TM, Swaminathan S, Greenstein AJ, Steinhagen RM (2018) Incidence and Factors Correlating With Incisional Hernia Following Open Bowel Resection in Patients With Inflammatory Bowel Disease. Ann Surg 267(3):532\u0026ndash;536. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/SLA.0000000000002120\u003c/span\u003e\u003cspan address=\"10.1097/SLA.0000000000002120\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLeitman IM, Horowitz ML (2008) Risk Factors for the Development of Incisional Hernia Following Roux-en- Y Gastric Bypass Surgery. Open Surg J 2(1):15\u0026ndash;17. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2174/1874300500802010015\u003c/span\u003e\u003cspan address=\"10.2174/1874300500802010015\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChavan SG, Nithin SN, Jaiswal K, Rambatla M (2020) Incidence of incisional hernia with respect to different sites and causes. Int Surg J 7(8):2539. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.18203/2349-2902.isj20203231\u003c/span\u003e\u003cspan address=\"10.18203/2349-2902.isj20203231\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBosanquet DC, Ansell J, Abdelrahman T et al (2015) Systematic Review and Meta-Regression of Factors Affecting Midline Incisional Hernia Rates: Analysis of 14 618 Patients. PLoS ONE 10(9):e0138745. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1371/journal.pone.0138745\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0138745\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYilmaz KB, Akinci M, Dogan L, Kahraman N, Ozaslan C, Atalay C (2013) A prospective evaluation of the risk factors for wound dehiscence and incisional hernia development. Turk J Surg Published online April 24. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.5152/UCD.2013.06\u003c/span\u003e\u003cspan address=\"10.5152/UCD.2013.06\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMir SA, Akram W, Gilkar IA, Bali RS, Mughal JI (2020) Short Term Incidence of Incisional Hernia after Emergency Midline Laparotomy. J Evid Based Med Healthc 7(12):591\u0026ndash;595. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.18410/jebmh/2020/130\u003c/span\u003e\u003cspan address=\"10.18410/jebmh/2020/130\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDai W, Chen Z, Zuo J, Tan J, Tan M, Yuan Y (2019) Risk factors of postoperative complications after emergency repair of incarcerated groin hernia for adult patients: a retrospective cohort study. Hernia 23(2):267\u0026ndash;276. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s10029-018-1854-5\u003c/span\u003e\u003cspan address=\"10.1007/s10029-018-1854-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFischer JP, Basta MN, Mirzabeigi MN et al (2016) A Risk Model and Cost Analysis of Incisional Hernia After Elective, Abdominal Surgery Based Upon 12,373 Cases. Ann Surg 263(5):1010\u0026ndash;1017. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/SLA.0000000000001394\u003c/span\u003e\u003cspan address=\"10.1097/SLA.0000000000001394\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSong IH, Ha HK, Choi SG, Jeon BG, Kim MJ, Park KJ (2012) Analysis of Risk Factors for the Development of Incisional and Parastomal Hernias in Patients after Colorectal Surgery. J Korean Soc Coloproctol 28(6):299. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3393/jksc.2012.28.6.299\u003c/span\u003e\u003cspan address=\"10.3393/jksc.2012.28.6.299\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAhn BK (2012) Risk Factors for Incisional Hernia and Parastomal Hernia after Colorectal Surgery. J Korean Soc Coloproctol 28(6):280. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3393/jksc.2012.28.6.280\u003c/span\u003e\u003cspan address=\"10.3393/jksc.2012.28.6.280\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eS\u0026ouml;derb\u0026auml;ck H, Gunnarsson U, Hellman P, Sandblom G (2018) Incisional hernia after surgery for colorectal cancer: a population-based register study. Int J Colorectal Dis 33(10):1411\u0026ndash;1417. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00384-018-3124-5\u003c/span\u003e\u003cspan address=\"10.1007/s00384-018-3124-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHodgson NCF, Malthaner RA, \u0026Oslash;stbye T (2000) The Search for an Ideal Method of Abdominal Fascial Closure. Ann Surg 231(3):436\u0026ndash;442. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/00000658-200003000-00018\u003c/span\u003e\u003cspan address=\"10.1097/00000658-200003000-00018\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDeerenberg EB, Henriksen NA, Antoniou GA et al (2022) Updated guideline for closure of abdominal wall incisions from the European and American Hernia Societies. Br J Surg 109(12):1239\u0026ndash;1250. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/bjs/znac302\u003c/span\u003e\u003cspan address=\"10.1093/bjs/znac302\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMuysoms FE, Deerenberg EB, Peeters E et al (2013) Recommendations for reporting outcome results in abdominal wall repair. Hernia 17(4):423\u0026ndash;433. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s10029-013-1108-5\u003c/span\u003e\u003cspan address=\"10.1007/s10029-013-1108-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBerr\u0026iacute;os-Torres SI, Umscheid CA, Bratzler DW et al (2017) Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017. JAMA Surg 152(8):784. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1001/jamasurg.2017.0904\u003c/span\u003e\u003cspan address=\"10.1001/jamasurg.2017.0904\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFink C, Baumann P, Wente MN et al (2013) Incisional hernia rate 3 years after midline laparotomy. Br J Surg 101(2):51\u0026ndash;54. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/bjs.9364\u003c/span\u003e\u003cspan address=\"10.1002/bjs.9364\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEeftinck Schattenkerk LD, Musters GD, Coultre SE, de Le WJ, van Heurn LE, Derikx JPM (2021) Incisional hernia after abdominal surgery in infants: A retrospective analysis of incidence and risk factors. J Pediatr Surg 56(11):2107\u0026ndash;2112. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jpedsurg.2021.01.037\u003c/span\u003e\u003cspan address=\"10.1016/j.jpedsurg.2021.01.037\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSpencer RJ, Hayes KD, Rose S et al (2015) Risk Factors for Early-Occurring and Late-Occurring Incisional Hernias After Primary Laparotomy for Ovarian Cancer. Obstet Gynecol 125(2):407\u0026ndash;413. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/AOG.0000000000000610\u003c/span\u003e\u003cspan address=\"10.1097/AOG.0000000000000610\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJargon D, Friebe V, Hopt U, Obermaier R (2008) Risikoprofil und Rezidivprophylaxe der Narbenhernie \u0026ndash; was ist evidenzbasiert? Zentralbl Chir 133(05):453\u0026ndash;457. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1055/s-2008-1076961\u003c/span\u003e\u003cspan address=\"10.1055/s-2008-1076961\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJang EJ, Kim MC, Nam SH (2018) Risk Factors for the Development of Incisional Hernia in Mini-laparotomy Wounds Following Laparoscopic Distal Gastrectomy in Patients with Gastric Cancer. J Gastric Cancer 18(4):392. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.5230/jgc.2018.18.e39\u003c/span\u003e\u003cspan address=\"10.5230/jgc.2018.18.e39\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUlukent SC, Erdem B, Seyhan NA, Canaz E, Sahbaz NA, Akbayir O (2016) Management of Enteroatmospheric Fistulae Developing Post Sitoreductive Surgery. J Acad Res Med 6(2):122\u0026ndash;125. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.5152/jarem.2016.929\u003c/span\u003e\u003cspan address=\"10.5152/jarem.2016.929\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSayur V, G\u0026uuml;ler E, Posacioglu H, Sezer TO, Fırat \u0026Ouml;, Ersin MS (2021) Incidence and risk factors for incisional hernia after abdominal aortic aneurysm and aortic occlusive disease surgery. Turkish J Thorac Cardiovasc Surg 29:465\u0026ndash;470. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://api.semanticscholar.org/CorpusID:240148825\u003c/span\u003e\u003cspan address=\"https://api.semanticscholar.org/CorpusID:240148825\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eH\u0026ouml;er J, Lawong G, Klinge U, Schumpelick V (2002) Einflussfaktoren der Narbenhernienentstehung Retrospektive Untersuchung an 2.983 laparotomierten Patienten \u0026uuml;ber einen Zeitraum von 10 Jahren. Chirurg 73(5):474\u0026ndash;480. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00104-002-0425-5\u003c/span\u003e\u003cspan address=\"10.1007/s00104-002-0425-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ede Alhambra-Rodr\u0026iacute;guez C, Morandeira-Rivas AJ, Herrero-Bogajo ML, Moreno-Sanz C (2020) Incidence and Risk Factors of Incisional Hernia After Single-Incision Endoscopic Surgery. J Laparoendosc Adv Surg Tech 30(3):251\u0026ndash;255. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1089/lap.2019.0728\u003c/span\u003e\u003cspan address=\"10.1089/lap.2019.0728\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYamamoto M, Takakura Y, Ikeda S, Itamoto T, Urushihara T, Egi H (2018) Visceral obesity is a significant risk factor for incisional hernia after laparoscopic colorectal surgery: A single-center review. Asian J Endosc Surg 11(4):373\u0026ndash;377. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/ases.12466\u003c/span\u003e\u003cspan address=\"10.1111/ases.12466\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Sana'a University","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Incisional hernia, prevalence, risk factors, abdominal surgery, wound dehiscence, nutritional status, Yemen","lastPublishedDoi":"10.21203/rs.3.rs-4889078/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4889078/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eIncisional hernia (IH) is a common and serious complication of abdominal surgery, but risk factors and optimal preventive strategies are not yet fully defined. This study aimed to determine the prevalence, timing and risk factors for IH following abdominal surgery in a high-risk patient population.\u003c/p\u003e\u003ch2\u003ePatients and Methods :\u003c/h2\u003e \u003cp\u003eA retrospective review of 222 patients who underwent abdominal surgery was conducted in two hospitals in Yemen. The demographics of the patients, surgical variables and postoperative outcomes were analyzed. The prevalence and timing of IH were determined and univariate and multivariate analyzes were performed to identify risk factors for IH.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe overall prevalence of IH was 19%, with 57% of cases occurring within 1 year after surgery (median 11 months). In the univariate analysis, significant risk factors for IH included ASA grade (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), smoking (p\u0026thinsp;=\u0026thinsp;0.044), diabetes (p\u0026thinsp;=\u0026thinsp;0.003), hypertension (p\u0026thinsp;=\u0026thinsp;0.044), malnutrition (p\u0026thinsp;=\u0026thinsp;0.022), trauma (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), peritonitis (p\u0026thinsp;=\u0026thinsp;0.001), surgical site infection (SSI) (p\u0026thinsp;=\u0026thinsp;0.015) and wound dehiscence (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In multivariate analysis, only postoperative wound dehiscence (odds ratio [OR] 9.874, 95% CI 3.317\u0026ndash;29.389, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and poor nutritional status (OR 9.899, 95% CI 1.777\u0026ndash;55.161, p\u0026thinsp;=\u0026thinsp;0.009) emerged as independent risk factors for IH.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eOur study found a higher prevalence of IH compared to some studies and identified several risk factors, including ASA, smoking, diabetes, hypertension, malnutrition, trauma, peritonitis, SSI and wound dehiscence. Wound dehiscence and poor nutritional status emerged as independent risk factors for the development of IH. Optimizing preoperative nutrition, managing postoperative infections, and preventing wound complications to reduce the risk of IH are crucial. More research is needed to explore the complex relationships between these factors and the occurrence of IH, ultimately leading to targeted interventions that can improve patient outcomes.\u003c/p\u003e","manuscriptTitle":"Prevalence and Risk Factors of Incisional Hernia Following Abdominal Surgery Among Yemeni Patients: A Retrospective Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-15 12:17:23","doi":"10.21203/rs.3.rs-4889078/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"05b1dc45-21cd-4e82-9c5d-7a0ba1efc3b1","owner":[],"postedDate":"August 15th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":35847100,"name":"General Surgery"}],"tags":[],"updatedAt":"2024-08-15T12:17:23+00:00","versionOfRecord":[],"versionCreatedAt":"2024-08-15 12:17:23","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4889078","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4889078","identity":"rs-4889078","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}