CT Assessment of the Visceral Fat as a Predictor of Early Post-Operative Complications after Hernioplasty

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Results At follow-up, 28.2% of patients had developed postoperative complications. The most frequent complication was surgical site infection (SSI) (25.4%) followed by, surgical site hematoma (4.2%) then cutaneous sinus tract (2.8%).Sensitivity analysis showed that defect size, visceral fat volume, and subcutaneous fat volume can significantly predict postoperative complications with cut-off values 2.9 cm, 125 cm 3 and 301 cm 3 with sensitivity 100%, 79%, 73.7% and specificity 79%, 65%, and 65% respectively. Conclusion Visceral fat volume (VFV) was significantly associated with postoperative complication following hernioplasty operation. This study suggests VFV as a risk assessment tool for patients undergoing hernioplasty. Obesity BMI Visceral Fat Volume Post-Operative Complications Hernioplasty Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Background Repairs of hernias, scars, and damage from previous surgeries are a few examples of abdominal wall procedures that can be performed in an obligatory or elective fashion. ( 8 ) A high body mass index (BMI) increases the likelihood of postoperative complications and hernia recurrence following abdominal wall operations. However, BMI doesn't give precise details on the amount and distribution of adipose tissue ( 2 ). Studies that have been published on the relation between visceral obesity and postoperative results have shown that visceral obesity is a better indicator of complications after a gastrectomy than body mass index. ( 6 ). Furthermore, according to ( 11 ), visceral obesity (VO) is associated with worse outcomes following colorectal and pancreatic cancer surgery. . ( 12 , 15 ), suggesting that visceral fat could be a significant clinical factor to consider while evaluating various types of surgeries. ( 2 ). Since body mass index (BMI) is based on anthropometric measurements, it cannot reveal details about the topographic distribution of adipose and lean tissue ratios. An increased risk of incisional hernia (IH) formation following colorectal surgery is linked to visceral obesity (VO), which can be quantified as the visceral fat volume (VFV) or the visceral fat area (VFA) from a single CT scan through the trans-umbilical plane. ( 1 , 17 ). Methods Study population and design We prospectively enrolled 71 patients who were candidates for hernioplasty operation. Patients had a mean age of 48 ± 14 years, males represented most of this population accounting for 77.5%. The study was performed at the CT unit at Kasr Al-aini hospital, during the period from May 2023 to December 2023. Approval of the Research Ethics Committee and informed consent were obtained from all participants in the study. Privacy of all patient data was guaranteed. The full socio-demographic and clinical data including age, sex, (BMI), smoking, medical history and past history of related significance. Informed consent Including procedure description and benefits was obtained. The exclusion criteria included: Insufficient CT quality, absolute contraindication for CT scan, e.g. pregnancy and patients refusing to participate. Imaging procedure Patient’s Preparation The aim of the patient preparation is to familiarize the patient with the procedure, to make the procedure as comfortable as possible and to stress the importance of minimizing the motion Position is supine (feet first) and asked to hold his breath during the examination Equipment: MSCT scan was performed by using 16 channels MSCT helical “GE revolution Evo 128 slice” machine in Radiology department, Faculty of medicine, Cairo university hospitals. Low dose MSCT scan is obtained with 1.25 mm slice thickness and 1.5 mm slice gap. Post processing was performed by using “GE AW volume share 7” workstation CT Imaging Protocol Non contrast enhanced CT scan of the abdomen and pelvis, including an acquisition at third lumbar vertebrae. In some cases the oral contrast material was administrated as a part of their preoperative assessment. Imaging analysis The morphological CT features including site, type, content, defect size and associated hernia complications. All these criteria were independently reviewed by two experienced radiologists for the documentation of these findings. Post processing Post processing of the volume axial CT images is then performed on the workstation without need for further patient stay in the CT machine. Post processing entangles manual delineation of the edges of visceral fat as well as subcutaneous fat (after exclusion of bowel, vessels, anterior abdominal wall muscles (anteriorly) as well as vertebral body and paraspinal muscles (posteriorly)) on every slice along L3 vertebral body using 3D reconstructed images, then visceral and subcutaneous fat volume are calculated automatically after applying regions of interest (ROI) on “GE A`W volume share 7” workstation. (Fig. 1 ) Post-operative patient evaluation Patients were followed up for postoperative 30-days duration for any early postoperative complications including surgical site infection, seroma or cardiopulmonary complications. Clinical and imaging data of the complicated cases were collected. Statistical Analysis Statistical analysis was conducted using SPSS 27th edition, categorical variables were presented in count and percent, and compared between groups using Chi2 test. Quantitative variables were presented in mean, standard deviation, minimum and maximum, while it was compared using Mann Whitney U test after normality testing by Shapiro Wilk test. Sensitivity analysis was conducted to estimate the optimum cutoff point for prediction of postoperative complications along with its sensitivity, specificity and area under the curve, logistic regression model was used to estimate the odds ratio for development of postoperative complications among the included patients. Any p value < 0.05 was considered significant. Results Socio- demographic and clinical data Among all study population 55 (77.5%) males, 16 (22.5%) females, their ages ranged between 34–62 years (mean age 48 ± 14 years). ( Fig. 2 ) Hypertension was the commonest reported comorbidity accounting for 31% followed by 9% cardiac diseases, and 7% diabetes. Smoking was reported by 57.7% of patients. Inguinal hernias were the most common type accounting for 66.2%, 12 (16.9%) patients had previous hernia, while 17 (23.9%) patients had previous abdominal surgeries. ( Fig. 3 )( Table 1 ) Table 1 Demographics, past history and medical comorbidities. Count % Age 48 ± 14 20–80 Gender Female 16 22.5% Male 55 77.5% cardiac comorbidity No 64 90.1% Yes 7 9.9% Hypertension No 49 69.0% Yes 22 31.0% Diabetes No 66 93.0% Yes 5 7.0% active smoking No 30 42.3% Yes 29 40.8% Yes (heavy) 12 16.9% hernia type bilateral inguinal 7 9.9% direct inguinal 25 35.2% Epigastric 2 2.8% incisional hernia 5 7.0% indirect inguinal 14 19.7% Paraumbilical hernia 4 5.6% recurrent incisional 2 2.8% recurrent epigastric 2 2.8% recurrent indirect inguinal 1 1.4% recurrent paraumbilical 5 7.0% recurrent umbilical 2 2.8% umbilical 2 2.8% previous hernia Epigastric 2 2.8% Incisional 2 2.8% Inguinal 1 1.4% Paraumbilical 5 7.0% Umbilical 2 2.8% No 59 83.1% previous operation appendicectomy 2 2.8% appendicectomy, herniotomy 1 1.4% CS 3 4.2% epigastric hernioplasty 2 2.8% hernioplasty 7 9.9% midline exploration 2 2.8% No 54 76.1% Computed tomography findings The mean defect size was 2.98 ± 1.34 cm, mean visceral fat volume 189 ± 192 cm3, and mean subcutaneous fat volume 371 ± 287 cm 3 . ( Table 2 ) Table 2 Defect size and fat contents. Mean ± SD Min-Max Defect size(cm) 2.98 ± 1.34 1.2-9 Visceral fat volume 189 ± 192 40–919 Subcutaneous fat volume 371 ± 287 57-1430 Post-operative complications The complications rate was 28.2%, most complicated cases developed SSI (n = 18, 25.4%) and 3 patients developed SS hematoma, and 2 patients developed cutaneous sinus tract ,while anesthesia related complications were 0% ( Table 3 ) ( Fig. 4 ) . Table 3 Postoperative complications. N % SSI No 53 74.6% Yes 18 25.4% cutaneous sinus tract No 69 97.2% Yes 2 2.8% Surgical site hematoma No 68 95.8% Yes 3 4.2% hernia recurrence No 70 98.6% Yes 1 1.4% anesthesia related complications No 71 100.0% Yes 0 0.0% Complications No 51 71.8% Yes 20 28.2% Factors associated with complications Complications were more prevalent among hypertensive patients (p 0.031), incisional hernias (p < 0.001), previous hernias (p 0.031), and previous abdominal surgeries 0.002. Complications were associated with higher defect size (2.5 ± 0.77 vs 4.17 ± 1.72 cm), higher visceral fat content (122 ± 85 vs 368 ± 272 cm3), and higher subcutaneous fat content (305 ± 219 vs 539 ± 368 cm3) with p values < 0.001, < 0.001, and < 0.001 respectively. ( Table 4 ) ( Fig. 5 ) ( Fig. 6 ) Table 4 factors associated with postoperative complications. Complications No Yes Count % Count % P value Age 46 ± 12 20–66 51 ± 16 23–80 0.252 Gender female 9 17.6% 7 35.0% 0.115 male 42 82.4% 13 65.0% cardiac comorbidity no 47 92.2% 17 85.0% 0.363 yes 4 7.8% 3 15.0% Hypertension no 39 76.5% 10 50.0% 0.03 yes 12 23.5% 10 50.0% diabetes no 49 96.1% 17 85.0% 0.101 yes 2 3.9% 3 15.0% active smoking no 20 39.2% 10 50.0% 0.709 yes 22 43.1% 7 35.0% yes (heavy) 9 17.6% 3 15.0% hernia type bilateral inguinal 3 5.9% 4 20.0% < 0.001 direct inguinal 25 49.0% 0 0.0% epigastric 2 3.9% 0 0.0% incisional hernia 0 0.0% 5 25.0% indirect inguinal 12 23.5% 2 10.0% Paraumbilical hernia 3 5.9% 1 5.0% recurrent incisional 2 3.9% 0 0.0% recurrent epigastric 0 0.0% 2 10.0% recurrent indirect inguinal 0 0.0% 1 5.0% recurrent paraumbilical 2 3.9% 3 15.0% recurrent umbilical 2 3.9% 0 0.0% umbilical 0 0.0% 2 10.0% previous hernia Epigastric 0 0.0% 2 10.0% 0.031 Incisional 2 3.9% 0 0.0% Inguinal 0 0.0% 1 5.0% no 45 88.2% 14 70.0% Paraumbilical 2 3.9% 3 15.0% Umbilical 2 3.9% 0 0.0% previous operation appendicectomy 0 0.0% 2 10.0% 0.002 appendicectomy, herniotomy 0 0.0% 1 5.0% CS 3 5.9% 0 0.0% epigastric hernioplasty 0 0.0% 2 10.0% hernioplasty 6 11.8% 1 5.0% midline exploration 0 0.0% 2 10.0% no 42 82.4% 12 60.0% defect size(cm) 2.5 ± 0.77 1.2–4.5 4.17 ± 1.72 3–9 < 0.001 visceral fat volume 122 ± 85 40–390 368 ± 272 110–919 < 0.001 subcutaneous fat volume 305 ± 219 57–817 539 ± 368 206–1430 < 0.001 Table 5 Sensitivity analysis for predictors of postoperative complications AUC P value 95% Confidence Interval cutoff sensitivity specificity Defect size(cm) 0.884 < 0.001 0.808–0.96 2.9 100% 79% Visceral fat volume 0.856 < 0.001 0.764–0.947 125 79% 65% Subcutaneous fat volume 0.75 0.001 0.636–0.863 301 73.7% 65% Cutoff points predicting complications Sensitivity analysis showed that defect size, visceral fat volume, and subcutaneous fat volume can significantly predict postoperative complications with cutoff values 2.9 cm, 125 cm3, and 301 cm3 with sensitivity 100%, 79%, 73.7% and specificity 79%, 65%, and 65% respectively, with p values < 0.01, and AUC 0.884, 0.856, and 0.75 respectively. The defect size, and visceral fat volume are independent predictors for postoperative complications with odds ratio 4.317 (95% CI 1.245–14.967), and 1.01 (95% CI 1-1.017) after adjustment for BMI and subcutaneous fat content. ( Table 6 ) they can significantly predict postoperative complications with cutoff values 2.9 cm, 125 cm 3 , and 301 cm3 with sensitivity 100%, 79%, 73.7% and specificity 79%, 65%, and 65% respectively, with p values < 0.01 and AUC 0.884, 0.856, and 0.75 respectively. (Table 7) ( Fig. 7 ) Table 6 Logistic regression model showing predictors of postoperative complications . P value OR 95% C.I. for OR Lower Upper BMI 0.575 1.101 0.786 1.544 defect size(cm) 0.021 4.317 1.245 14.967 visceral fat volume 0.045 1.008 1 1.017 subcutaneous fat volume 0.55 0.999 0.995 1.003 Discussion Obesity, diabetes, smoking, increased defect size, prior IH repair, rising contamination grade, and postoperative wound complications are risk factors for post-operative complications or hernia recurrence after abdominal wall procedures ( 9 , 10 ) It has been stated that patients who are obese experience longer hospital stays, more readmissions to the hospital, and an increase in problems like surgical site infections following surgery. ( 14.18) Traditionally, body mass index (BMI) is used to measure obesity. Researches has linked elevated BMI to hernia recurrence following AWR. ( 7 ). Since BMI is an anthropometric measure, it cannot reveal information on the topographic distribution of adipose and lean tissue ratios.( 2 ) As a reliable substitute for BMI, computed tomography (CT) measures accurately body composition. (4,14.18) Visceral obesity (VO), measured by either the visceral fat area (VFA) from a single CT slice through the trans-umbilical plane or as the visceral fat volume (VFV) with an increased risk of IH formation after colorectal surgery. ( 1 , 17 ) From May 2023 to December 2023 our cohort study involved 71 patients who patients underwent hernioplasty operation. The mean age was 48 ± 14 years, males represented most of this population accounting for 77.5% of the included patients. All patients underwent a preoperative non-enhanced abdominal CT scan as a part of the preoperative planning. Measurements were done by manual delineation of the visceral fat as well as subcutaneous fat on every axial slice along 3rd lumbar vertebral body (L3) using 3D reconstructed images. Patients were followed for 30 days for detection of early post-operative complications including surgical site infection, seroma and venous thromboembolism. Clinical and imaging data of the complicated cases were collected. In our study, the incidence of early (30 day) postoperative complications was (28.2%), the most frequent complication was SSI (n = 18) followed by, surgical site hematoma (n = 3) then cutaneous sinus tract (n = 2) In agreement with ( 3 ) which found that (26%) of total included patients developed a postoperative complication following Incisional Hernia Repair in Abdominal Transplant Population within the first 30 days. In the present study we found that visceral fat is a strong predictor of postoperative complications following herniplasty while it is the only predictor of postoperative complications following abdominal wall reconstruction surgeries using cutoff value 125 cm 3 with sensitivity 79%, while specificity 65% in hernioplasty as well as abdominal wall reconstruction surgeries with cutoff value 445 cm3 with sensitivity 81.3%, and while specificity 80%, respectively. Concordant with ( 2 ), that demonstrated positive association between increased VFV development of SSO after AWR. These results are also matched with ( 6 ) reported that visceral obesity (VO) to be superior to BMI in the prediction of complications after laparoscopic gastrectomy. And also with ( 11 ) which found that visceral obesity is associated with worse outcomes after surgery for pancreatic, indicating that VO may be an important clinical parameter in the preoperative assessment of several types of surgery. In the present study we found that complications in the hernioplasty groups was more prevalent among hypertensive patients (p 0.031), incisional hernias (p < 0.001) previous hernias (p 0.031), and previous abdominal surgeries (p 0.002). While In abdominal wall reconstruction group we detected that complications was more prevalent among diabetes, hypertension, and smoker patients ,also incisional hernias, previous hernia and previous abdominal surgeries p values(< 0.001) (0.002), (< 0.001), (0.024) ,( 0.014) and (0.004) respectively. In concordance with (Cheema et al., 2021) which reported that history of diabetes and open abdomen are associated with SSO/SSIs, while hypertension is associated with recurrence in abdominal organ transplant patients. This is consistent with prior literature that patient selection plays an important role in hernia surgery. Also in agreement with ( 13 ) which found that a significant relationship between diabetes mellitus and smoking and the occurrence of complications in patients with incisional hernia repair Our results demonstrated that no association between BMI and occurrence of early postoperative complications following hernioplasty– probably due to low BMI among the included participants. In acceptance with ( 2 ) which demonstrated that there is no such association between BMI and occurrence of post-operative complications or hernia recurrence following abdominal wall surgeries ( AWR) Mismatched with ( 3 ) which concluded (BMI) > 35 kg/m2, was associated with surgical site occurrence / infection (SSO/I) (P < .05) Our study also found that the defect size of abdominal wall hernia, can significantly predict postoperative complications following herniopasty using cutoff value 2.9, with sensitivity 100% and specificity 79%. In agreement ( 5 ) which reported that defect width larger than 10 cm and reoperation within 90 days were factors independently associated with operation for hernia recurrence following incisional hernia repair, as well as ( 13 ) which found a significant relationship between defect size and the occurrence of complications in patients with incisional hernia repair. We detected that subcutaneous fat contents can also be used as a predictor postoperative complications following hernioplasty using cutoff value 301 cm3 with sensitivity 73.7%, while specificity 65%. In agreement with ( 16 ) which revealed subcutaneous fat volume per 1000 cm3 (p = 0.034, OR = 0.26) was significant predictor of SSI following complex ventral hernia repair. Limitations of this study First, our study has some limits such as being a small study cohort, done at single-institution. Second, we only had partial follow-up data for a short time; therefore, long-term outcomes, such as hernia recurrence, could not be determined. Also, the small sample size, which may have caused selection bias. Furthermore the Limited area of measurement of body fat volume, along L3 vertebral body (due to lack of automated protocols in our institute), which is sometimes affected with structural pathology (i.e.: fracture). Finally, relative inaccessible some of intra-operative and post-operative recovery data as well as Lack of documentation in our institution. Conclusion We concluded that visceral fat volume (VFV) was significantly associated with postoperative complication following hernioplasty operation. This study suggests VFV as a risk assessment tool for patients undergoing hernioplasty. Abbreviations AWR Abdominal wall reconstruction surgery BMI Body mass index CT Computed tomography IH Incisional hernia L3 3rd lumbar vertebra MSCT Multi-slice computed tomography ROI region of interest SSI Surgical site infection SSO Surgical site occurrence VFA Visceral fat area VFV Visceral fat volume VO visceral obesity Declarations Funding: not applicable (no funding) Author Contribution o M.S.A Put the idea of the study. CT assessment and performed the statistical analysis o I.H.A Participated in the study design and CT assessmento M.S data collection and clinical assessment of the patients. o A.S.H Editor of the manuscript. Participation in the study design.o All authors read and approved the final manuscript. References Aquina, C.T., Rickles, A.S., Probst, C.P., Kelly, K.N., Deeb, A.P., Monson, J.R., Fleming, F.J. and Muscle and Adiposity Research Consortium, 2015. Visceral obesity, not elevated BMI, is strongly associated with incisional hernia after colorectal surgery. Diseases of the Colon & Rectum, 58(2), pp.220–227. Baastrup, N.N., Jensen, K.K., Christensen, J.K. and Jorgensen, L.N., 2022. Visceral obesity is a predictor of surgical site occurrence and hernia recurrence after open abdominal wall reconstruction. Hernia, pp.1–7. C Cheema, F., Andacoglu, O., Huang, L.C., Phillips, S.E. and Malcher, F., 2021, March. Risk factors for surgical site occurrence or infection and recurrence after incisional hernia repair in abdominal transplant population. In Transplantation proceedings (Vol. 53, No. 2, pp. 762–767). Elsevier. Du, Y., Karvellas, C.J., Baracos, V., Williams, D.C., Khadaroo, R.G. and Group, E.S.A., 2014. Sarcopenia is a predictor of outcomes in very elderly patients undergoing emergency surgery. Surgery, 156(3), pp.521–527. Henriksen, N.A., Friis-Andersen, H., Jorgensen, L.N. and Helgstrand, F., 2021. Open versus laparoscopic incisional hernia repair: nationwide database study. BJS open, 5(1), p.zraa010. Imai, Y., Lee, S.W., Kawai, M., Tashiro, K., Kawashima, S., Tanaka, R., Honda, K., Matsuo, K. and Uchiyama, K., 2022. Visceral fat area is a better indicator of surgical outcomes after laparoscopic gastrectomy for cancer than the body mass index: a propensity score-matched analysis. Surgical Endoscopy, 36(5), pp.3285–3297. Juvany, M., Hoyuela, C., Carvajal, F., Trias, M., Martrat, A. and Ardid, J., 2018. Long-term follow-up (at 5 years) of midline incisional hernia repairs using a primary closure and prosthetic onlay technique: recurrence and quality of life. Hernia, 22, pp.319–324. Khansa, I. and Janis, J.E., 2019. The 4 principles of complex abdominal wall reconstruction. Plastic and Reconstructive Surgery Global Open, 7(12). Kokotovic, D., Bisgaard, T. and Helgstrand, F., 2016. Long-term recurrence and complications associated with elective incisional hernia repair. Jama, 316(15), pp.1575–1582. Lin, H.J., Spoerke, N., Deveney, C. and Martindale, R., 2009. Reconstruction of complex abdominal wall hernias using acellular human dermal matrix: a single institution experience. The American journal of surgery, 197(5), pp.599-603.5. Okumura, S., Kaido, T., Hamaguchi, Y., Kobayashi, A., Shirai, H., Yao, S., Yagi, S., Kamo, N., Hatano, E., Okajima, H. and Takaori, K., 2017. Visceral adiposity and sarcopenic visceral obesity are associated with poor prognosis after resection of pancreatic cancer. Annals of Surgical Oncology, 24, pp.3732–3740. Park, J.W., Chang, S.Y., Lim, J.S., Park, S.J., Park, J.J., Cheon, J.H., Kim, W.H. and Kim, T.I., 2022. Impact of visceral fat on survival and metastasis of stage III colorectal cancer. Gut and liver, 16(1), p.53. Rana, K.V., Singh, G., Deshpande, N.A., Bharathan, V.K. and Sridharan, S., 2013. Postoperative complications of mesh hernioplasty for incisional hernia repair and factors affecting the occurrence of complications. Medical Journal of Dr. DY Patil University, 6(1), pp.25–31. Saravana-Bawan, B., Goplen, M., Alghamdi, M. and Khadaroo, R.G., 2021. The relationship between visceral obesity and post-operative complications: a meta-analysis. Journal of Surgical Research, 267, pp.71–81. Verduin WM, Warps AK, van den Helder R, Doodeman HJ, Houdijk APJ, Fat IN et al (2021) Visceral fat and anastomotic leakage after colon cancer resection. Dis Colon Rectum 64(2):163–170 Winters, H., Knaapen, L., Buyne, O.R., Hummelink, S., Ulrich, D.J.O., Van Goor, H., Van Geffen, E. and Slater, N.J., 2019. Pre-operative CT scan measurements for predicting complications in patients undergoing complex ventral hernia repair using the component separation technique. Hernia, 23, pp.347–354. Yamamoto, M., Takakura, Y., Ikeda, S., Itamoto, T., Urushihara, T. and Egi, H., 2018. Visceral obesity is a significant risk factor for incisional hernia after laparoscopic colorectal surgery: A single-center review. Asian Journal of Endoscopic Surgery, 11(4), pp.373–377 Yang, S.J., Li, H.R., Zhang, W.H., Liu, K., Zhang, D.Y., Sun, L.F., Chen, X.L., Zhao, L.Y., Chen, X.Z., Yang, K. and Chen, Z.X., 2020. Visceral fat area (VFA) superior to BMI for predicting postoperative complications after radical gastrectomy: a prospective cohort study. Journal of Gastrointestinal Surgery, 24, pp.1298–1306. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 18 Aug, 2025 Read the published version in Egyptian Journal of Radiology and Nuclear Medicine → Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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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-5286881","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":373779067,"identity":"c3349357-9ae6-41e9-83a8-07e3f3976242","order_by":0,"name":"Islam Haney 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06:23:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5286881/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5286881/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s43055-025-01558-2","type":"published","date":"2025-08-18T16:29:42+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":69077837,"identity":"94fd87cb-cbce-4eb9-a99a-9f1bfb1a9df7","added_by":"auto","created_at":"2024-11-15 11:24:27","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":92477,"visible":true,"origin":"","legend":"\u003cp\u003eDemonstration of method of visceral fat volume measurement along L3 vertebral body using 3D reconstructed images. manual delineation of the edges of visceral fat or subcutaneous fat on axial image causing simultaneously automatic delineation of the slice thickness included on the sagittal and coronal images\u003c/p\u003e","description":"","filename":"figure1VFVmeasurement.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5286881/v1/b9797e1c38ee94c0c30f5b0c.jpg"},{"id":69077873,"identity":"f357341c-8f2c-4bc4-990c-c9eeef33731e","added_by":"auto","created_at":"2024-11-15 11:24:34","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":23017,"visible":true,"origin":"","legend":"\u003cp\u003ePie chart showing gender distribution among hernioplasty group.\u003c/p\u003e","description":"","filename":"figure2pieofgender1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5286881/v1/b42c05d243cacdf1bf28de94.jpg"},{"id":69077864,"identity":"c150bcf8-203c-49e0-8dfd-a5b060780d94","added_by":"auto","created_at":"2024-11-15 11:24:30","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":64874,"visible":true,"origin":"","legend":"\u003cp\u003eBar chart showing past surgical history among hernioplasty group\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"figure3barcharttypeofhernia.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5286881/v1/6d13563ce310ccfe4f152c0f.jpg"},{"id":69077871,"identity":"5d7456c4-3796-42f2-b7b3-6997c1f4b2ee","added_by":"auto","created_at":"2024-11-15 11:24:33","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":64874,"visible":true,"origin":"","legend":"\u003cp\u003eBar chart showing type of hernia.\u003c/p\u003e","description":"","filename":"figure4barcharttypeofhernia.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5286881/v1/b6874f6d2b7f06c3910916c7.jpg"},{"id":69077838,"identity":"de637b5f-906f-4960-8dc8-a9e7d4a7c43c","added_by":"auto","created_at":"2024-11-15 11:24:27","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":33719,"visible":true,"origin":"","legend":"\u003cp\u003eBox plot showing subcutaneous fat distribution according to postoperative complications.\u003c/p\u003e","description":"","filename":"figure5scfatdistributionandpostoperativecomplications1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5286881/v1/e0acac0c4aac0f1a29f20152.jpg"},{"id":69077845,"identity":"e74d4958-df68-40b3-aa36-5860da082f82","added_by":"auto","created_at":"2024-11-15 11:24:29","extension":"jpg","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":35647,"visible":true,"origin":"","legend":"\u003cp\u003eBox plot showing visceral fat distribution according to postoperative complications.\u003c/p\u003e","description":"","filename":"figure6vfvandcomp.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5286881/v1/334de8a4db5e5196b1ad0821.jpg"},{"id":69077877,"identity":"75a0d441-701f-4a0f-99bb-510a01a550bd","added_by":"auto","created_at":"2024-11-15 11:24:37","extension":"jpg","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":30125,"visible":true,"origin":"","legend":"\u003cp\u003eROC curve showing predictors of postoperative complications among hernioplasty group.\u003c/p\u003e","description":"","filename":"figure7roccurve.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5286881/v1/842c1844a9b850b853ccc8f5.jpg"},{"id":69077880,"identity":"5f44c34f-552b-49a7-a8a7-77b6b909df77","added_by":"auto","created_at":"2024-11-15 11:24:37","extension":"jpg","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":162949,"visible":true,"origin":"","legend":"\u003cp\u003eA 63-year-old non diabetic or hypertensive, smoker , surgically free male patient, with BMI =27.7 ,presented with right fat containing and left bowel containing inguinal hernia of 2 years duration, underwent bilateral inguinal hernioplasty, post-operative patient complained of post-operative fever and lower abdominal pain and right inguinal swelling.\u003cstrong\u003e (A)\u003c/strong\u003e Preoperative non enhanced CT abdomen and pelvis scan (axial image) showing right fat containing with defect size =3.4 cm (red arrow) and left bowel containing direct inguinal hernia with defect size =3.5 cm (blue arrow)\u003cstrong\u003e (B)\u003c/strong\u003e L3 visceral fat volume = 152 cm\u003csup\u003e3\u003c/sup\u003e\u003cstrong\u003e (C)\u003c/strong\u003e L3 level subcutaneous fat volume =301 cm\u003csup\u003e3\u003c/sup\u003e \u003cstrong\u003e(D)\u003c/strong\u003e postoperative non enhanced CT abdomen and pelvis scan (axial image) revealed diffuse inflammatory changes with mild skin thickening, smudging of the related subcutaneous fat planes merging with sheets of soft tissue densities on the left side (red arrow). Recurrent right fat containing inguinal hernia with noted surgical clips (green notched arrow)\u003c/p\u003e","description":"","filename":"figure8.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5286881/v1/390bbe2ce0be110c63855488.jpg"},{"id":69077882,"identity":"95402a36-48ae-4c57-a0e8-49a0431cc38c","added_by":"auto","created_at":"2024-11-15 11:24:38","extension":"jpg","order_by":9,"title":"Figure 9","display":"","copyAsset":false,"role":"figure","size":117656,"visible":true,"origin":"","legend":"\u003cp\u003eA 43-year-old non diabetic or hypertensive, smoker male patient, with BMI =27 kg/m2, has past surgical history of midline exploration, presented with midline incisional hernia, underwent midline hernioplasty. Post-operative patient complained of high grade fever and lower abdominal pain \u003cstrong\u003e(A)\u003c/strong\u003e Preoperative non enhanced CT abdomen and pelvis scan (axial image) showing non complicated huge midline omentum and bowel and containing anterior abdominal wall hernia , with a defect measuring about 9 cm \u003cstrong\u003e(B) \u003c/strong\u003eL3 visceral fat volume = 773 cm\u003csup\u003e3\u003c/sup\u003e \u003cstrong\u003e(C) \u003c/strong\u003eL3 level subcutaneous fat volume =1137 cm\u003csup\u003e3\u003c/sup\u003e (\u003cstrong\u003eD)\u003c/strong\u003e postoperative non enhanced CT abdomen and pelvis scan (axial image), revealed Anterior abdominal wall soft tissue lesion with multiple internal air loculi and smudged fat planes extends underneath \u0026amp; inseparable from the related rectus muscle (red arrow head )\u003c/p\u003e","description":"","filename":"figure94.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5286881/v1/0ec7965bab697e067deb20a0.jpg"},{"id":69077878,"identity":"37f46b16-a0ce-4aec-8473-bbaf1666ecb7","added_by":"auto","created_at":"2024-11-15 11:24:37","extension":"jpg","order_by":10,"title":"Figure 10","display":"","copyAsset":false,"role":"figure","size":159916,"visible":true,"origin":"","legend":"\u003cp\u003eA 48-year-old non diabetic or hypertensive, smoker, surgically free male patient, with BMI =26, presented with right fat containing indirect inguinal hernia of 1 years duration, underwent right inguinal hernioplasty. His 30-day follow up : was un-eventable.\u003cstrong\u003e (A)\u003c/strong\u003e Preoperative non enhanced CT abdomen and pelvis scan (axial image) showing Right fat containing indirect inguinal hernia with a defect measuring about 2.5 cm\u0026nbsp;\u0026nbsp; ( red arrow head )\u003cstrong\u003e (B) \u003c/strong\u003eL3 visceral fat volume = 124 cm\u003csup\u003e3\u003c/sup\u003e \u003cstrong\u003e(C) \u003c/strong\u003eL3 level subcutaneous fat volume =364 cm\u003csup\u003e3\u003c/sup\u003e.\u003c/p\u003e","description":"","filename":"figure10.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5286881/v1/a6b3c1e6e2de54041f1efa15.jpg"},{"id":89847739,"identity":"0640e39d-fd48-4a19-81dc-556199474720","added_by":"auto","created_at":"2025-08-25 16:44:12","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1837405,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5286881/v1/fc5c7d5b-54c1-4eb0-9894-b0def1ee5f01.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"CT Assessment of the Visceral Fat as a Predictor of Early Post-Operative Complications after Hernioplasty","fulltext":[{"header":"Background","content":"\u003cp\u003eRepairs of hernias, scars, and damage from previous surgeries are a few examples of abdominal wall procedures that can be performed in an obligatory or elective fashion. (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eA high body mass index (BMI) increases the likelihood of postoperative complications and hernia recurrence following abdominal wall operations. However, BMI doesn't give precise details on the amount and distribution of adipose tissue (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Studies that have been published on the relation between visceral obesity and postoperative results have shown that visceral obesity is a better indicator of complications after a gastrectomy than body mass index.\u003c/p\u003e \u003cp\u003e(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Furthermore, according to (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e), visceral obesity (VO) is associated with worse outcomes following colorectal and pancreatic cancer surgery.\u003c/p\u003e \u003cp\u003e. (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), suggesting that visceral fat could be a significant clinical factor to consider while evaluating various types of surgeries.\u003c/p\u003e \u003cp\u003e(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Since body mass index (BMI) is based on anthropometric measurements, it cannot reveal details about the topographic distribution of adipose and lean tissue ratios. An increased risk of incisional hernia (IH) formation following colorectal surgery is linked to visceral obesity (VO), which can be quantified as the visceral fat volume (VFV) or the visceral fat area (VFA) from a single CT scan through the trans-umbilical plane. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy population and design\u003c/h2\u003e \u003cp\u003eWe prospectively enrolled 71 patients who were candidates for hernioplasty operation. Patients had a mean age of 48\u0026thinsp;\u0026plusmn;\u0026thinsp;14 years, males represented most of this population accounting for 77.5%. The study was performed at the CT unit at Kasr Al-aini hospital, during the period from May 2023 to December 2023. Approval of the Research Ethics Committee and informed consent were obtained from all participants in the study. Privacy of all patient data was guaranteed.\u003c/p\u003e \u003cp\u003eThe full socio-demographic and clinical data including age, sex, (BMI), smoking, medical history and past history of related significance. Informed consent Including procedure description and benefits was obtained.\u003c/p\u003e \u003cp\u003eThe exclusion criteria included: Insufficient CT quality, absolute contraindication for CT scan, e.g. pregnancy and patients refusing to participate.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eImaging procedure\u003c/h3\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003ePatient\u0026rsquo;s Preparation\u003c/h2\u003e \u003cp\u003eThe aim of the patient preparation is to familiarize the patient with the procedure, to make the procedure as comfortable as possible and to stress the importance of minimizing the motion Position is supine (feet first) and asked to hold his breath during the examination\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eEquipment:\u003c/h3\u003e\n\u003cp\u003eMSCT scan was performed by using 16 channels MSCT helical \u0026ldquo;GE revolution Evo 128 slice\u0026rdquo; machine in Radiology department, Faculty of medicine, Cairo university hospitals. Low dose MSCT scan is obtained with 1.25 mm slice thickness and 1.5 mm slice gap.\u003c/p\u003e \u003cp\u003ePost processing was performed by using \u0026ldquo;GE AW volume share 7\u0026rdquo; workstation\u003c/p\u003e\n\u003ch3\u003eCT Imaging Protocol\u003c/h3\u003e\n\u003cp\u003eNon contrast enhanced CT scan of the abdomen and pelvis, including an acquisition at third lumbar vertebrae. In some cases the oral contrast material was administrated as a part of their preoperative assessment.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eImaging analysis\u003c/h2\u003e \u003cp\u003eThe morphological CT features including site, type, content, defect size and associated hernia complications.\u003c/p\u003e \u003cp\u003eAll these criteria were independently reviewed by two experienced radiologists for the documentation of these findings.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePost processing\u003c/h3\u003e\n\u003cp\u003ePost processing of the volume axial CT images is then performed on the workstation without need for further patient stay in the CT machine.\u003c/p\u003e \u003cp\u003ePost processing entangles manual delineation of the edges of visceral fat as well as subcutaneous fat (after exclusion of bowel, vessels, anterior abdominal wall muscles (anteriorly) as well as vertebral body and paraspinal muscles (posteriorly)) on every slice along L3 vertebral body using 3D reconstructed images, then visceral and subcutaneous fat volume are calculated automatically after applying regions of interest (ROI) on \u0026ldquo;GE A`W volume share 7\u0026rdquo; workstation. (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\n\u003ch3\u003ePost-operative patient evaluation\u003c/h3\u003e\n\u003cp\u003ePatients were followed up for postoperative 30-days duration for any early postoperative complications including surgical site infection, seroma or cardiopulmonary complications.\u003c/p\u003e \u003cp\u003eClinical and imaging data of the complicated cases were collected.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eStatistical analysis was conducted using SPSS 27th edition, categorical variables were presented in count and percent, and compared between groups using Chi2 test. Quantitative variables were presented in mean, standard deviation, minimum and maximum, while it was compared using Mann Whitney U test after normality testing by Shapiro Wilk test. Sensitivity analysis was conducted to estimate the optimum cutoff point for prediction of postoperative complications along with its sensitivity, specificity and area under the curve, logistic regression model was used to estimate the odds ratio for development of postoperative complications among the included patients. Any p value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eSocio- demographic and clinical data\u003c/h2\u003e \u003cp\u003eAmong all study population 55 (77.5%) males, 16 (22.5%) females, their ages ranged between 34\u0026ndash;62 years (mean age 48\u0026thinsp;\u0026plusmn;\u0026thinsp;14 years). \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eHypertension was the commonest reported comorbidity accounting for 31% followed by 9% cardiac diseases, and 7% diabetes. Smoking was reported by 57.7% of patients.\u003c/p\u003e \u003cp\u003eInguinal hernias were the most common type accounting for 66.2%, 12 (16.9%) patients had previous hernia, while 17 (23.9%) patients had previous abdominal surgeries. \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\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 \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\u003eDemographics, past history and medical comorbidities.\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=\"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=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCount\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48\u0026thinsp;\u0026plusmn;\u0026thinsp;14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20\u0026ndash;80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e77.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ecardiac comorbidity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e90.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.9%\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=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e69.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e93.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eactive smoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes (heavy)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ehernia type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ebilateral inguinal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003edirect inguinal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEpigastric\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eincisional hernia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eindirect inguinal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eParaumbilical hernia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003erecurrent incisional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003erecurrent epigastric\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003erecurrent indirect inguinal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003erecurrent paraumbilical\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003erecurrent umbilical\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eumbilical\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eprevious hernia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEpigastric\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncisional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInguinal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eParaumbilical\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUmbilical\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e83.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eprevious operation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eappendicectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eappendicectomy, herniotomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eepigastric hernioplasty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ehernioplasty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emidline exploration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e76.1%\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 \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eComputed tomography findings\u003c/h2\u003e \u003cp\u003eThe mean defect size was 2.98\u0026thinsp;\u0026plusmn;\u0026thinsp;1.34 cm, mean visceral fat volume 189\u0026thinsp;\u0026plusmn;\u0026thinsp;192 cm3, and mean subcutaneous fat volume 371\u0026thinsp;\u0026plusmn;\u0026thinsp;287 cm\u003csup\u003e3\u003c/sup\u003e. \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\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\u003eDefect size and fat contents.\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=\"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=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMin-Max\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eDefect size(cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.98\u0026thinsp;\u0026plusmn;\u0026thinsp;1.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.2-9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eVisceral fat volume\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e189\u0026thinsp;\u0026plusmn;\u0026thinsp;192\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40\u0026ndash;919\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSubcutaneous fat volume\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e371\u0026thinsp;\u0026plusmn;\u0026thinsp;287\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57-1430\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 \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003ePost-operative complications\u003c/h2\u003e \u003cp\u003eThe complications rate was 28.2%, most complicated cases developed SSI (n\u0026thinsp;=\u0026thinsp;18, 25.4%) and 3 patients developed SS hematoma, and 2 patients developed cutaneous sinus tract ,while anesthesia related complications were 0% \u003cb\u003e(\u003c/b\u003e Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e \u003cb\u003e) (\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e\u003cb\u003e)\u003c/b\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\u003ePostoperative complications.\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=\"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=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSSI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e74.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ecutaneous sinus tract\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e97.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical site hematoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ehernia recurrence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e98.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eanesthesia related complications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e71.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eFactors associated with complications\u003c/h2\u003e \u003cp\u003eComplications were more prevalent among hypertensive patients (p 0.031), incisional hernias (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), previous hernias (p 0.031), and previous abdominal surgeries 0.002.\u003c/p\u003e \u003cp\u003eComplications were associated with higher defect size (2.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.77 vs 4.17\u0026thinsp;\u0026plusmn;\u0026thinsp;1.72 cm), higher visceral fat content (122\u0026thinsp;\u0026plusmn;\u0026thinsp;85 vs 368\u0026thinsp;\u0026plusmn;\u0026thinsp;272 cm3), and higher subcutaneous fat content (305\u0026thinsp;\u0026plusmn;\u0026thinsp;219 vs 539\u0026thinsp;\u0026plusmn;\u0026thinsp;368 cm3) with p values\u0026thinsp;\u0026lt;\u0026thinsp;0.001, \u0026lt;\u0026thinsp;0.001, and \u0026lt;\u0026thinsp;0.001 respectively.\u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e\u003cb\u003e) (\u003c/b\u003e Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e\u003cb\u003e) (\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\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\u003efactors associated with postoperative complications.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\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=\"left\" 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=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eComplications\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCount\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCount\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46\u0026thinsp;\u0026plusmn;\u0026thinsp;12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20\u0026ndash;66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e51\u0026thinsp;\u0026plusmn;\u0026thinsp;16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e23\u0026ndash;80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.252\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e35.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.115\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e82.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e65.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ecardiac comorbidity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e92.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e85.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.363\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e76.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e50.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e50.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ediabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e96.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e85.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.101\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eactive smoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e50.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.709\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e35.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyes (heavy)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ehernia type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ebilateral inguinal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003edirect inguinal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eepigastric\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eincisional hernia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e25.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eindirect inguinal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eParaumbilical hernia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003erecurrent incisional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003erecurrent epigastric\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003erecurrent indirect inguinal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003erecurrent paraumbilical\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003erecurrent umbilical\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eumbilical\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eprevious hernia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEpigastric\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.031\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncisional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInguinal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e88.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e70.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eParaumbilical\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUmbilical\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eprevious operation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eappendicectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eappendicectomy, herniotomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eepigastric hernioplasty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ehernioplasty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emidline exploration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e82.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e60.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003edefect size(cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.2\u0026ndash;4.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.17\u0026thinsp;\u0026plusmn;\u0026thinsp;1.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3\u0026ndash;9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003evisceral fat volume\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e122\u0026thinsp;\u0026plusmn;\u0026thinsp;85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40\u0026ndash;390\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e368\u0026thinsp;\u0026plusmn;\u0026thinsp;272\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e110\u0026ndash;919\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003esubcutaneous fat volume\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e305\u0026thinsp;\u0026plusmn;\u0026thinsp;219\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57\u0026ndash;817\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e539\u0026thinsp;\u0026plusmn;\u0026thinsp;368\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e206\u0026ndash;1430\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSensitivity analysis for predictors of postoperative complications\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\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=\"left\" 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=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAUC\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95% Confidence Interval\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ecutoff\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003esensitivity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003especificity\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDefect size(cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.884\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.808\u0026ndash;0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e79%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVisceral fat volume\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.856\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.764\u0026ndash;0.947\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e79%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e65%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSubcutaneous fat volume\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.636\u0026ndash;0.863\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e301\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e73.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e65%\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 \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eCutoff points predicting complications\u003c/h2\u003e \u003cp\u003eSensitivity analysis showed that defect size, visceral fat volume, and subcutaneous fat volume can significantly predict postoperative complications with cutoff values 2.9 cm, 125 cm3, and 301 cm3 with sensitivity 100%, 79%, 73.7% and specificity 79%, 65%, and 65% respectively, with p values\u0026thinsp;\u0026lt;\u0026thinsp;0.01, and AUC 0.884, 0.856, and 0.75 respectively.\u003c/p\u003e \u003cp\u003eThe defect size, and visceral fat volume are independent predictors for postoperative complications with odds ratio 4.317 (95% CI 1.245\u0026ndash;14.967), and 1.01 (95% CI 1-1.017) after adjustment for BMI and subcutaneous fat content. \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e they can significantly predict postoperative complications with cutoff values 2.9 cm, 125 cm\u003csup\u003e3\u003c/sup\u003e, and 301 cm3 with sensitivity 100%, 79%, 73.7% and specificity 79%, 65%, and 65% respectively, with p values\u0026thinsp;\u0026lt;\u0026thinsp;0.01 and AUC 0.884, 0.856, and 0.75 respectively. \u003cb\u003e(Table\u0026nbsp;7) (\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLogistic regression model showing predictors of postoperative complications \u003cb\u003e.\u003c/b\u003e\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=\"left\" 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\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e95% C.I. for OR\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\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 \u003cp\u003eLower\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUpper\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.575\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.786\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.544\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003edefect size(cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.317\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.245\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14.967\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003evisceral fat volume\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.045\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.017\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003esubcutaneous fat volume\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.995\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eObesity, diabetes, smoking, increased defect size, prior IH repair, rising contamination grade, and postoperative wound complications are risk factors for post-operative complications or hernia recurrence after abdominal wall procedures (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eIt has been stated that patients who are obese experience longer hospital stays, more readmissions to the hospital, and an increase in problems like surgical site infections following surgery. (\u003cb\u003e14.18)\u003c/b\u003e\u003c/p\u003e \u003cp\u003eTraditionally, body mass index (BMI) is used to measure obesity. Researches has linked elevated BMI to hernia recurrence following AWR. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Since BMI is an anthropometric measure, it cannot reveal information on the topographic distribution of adipose and lean tissue ratios.(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) As a reliable substitute for BMI, computed tomography (CT) measures accurately body composition. \u003cb\u003e(4,14.18)\u003c/b\u003e\u003c/p\u003e \u003cp\u003eVisceral obesity (VO), measured by either the visceral fat area (VFA) from a single CT slice through the trans-umbilical plane or as the visceral fat volume (VFV) with an increased risk of IH formation after colorectal surgery. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eFrom May 2023 to December 2023 our cohort study involved 71 patients who patients underwent hernioplasty operation. The mean age was 48\u0026thinsp;\u0026plusmn;\u0026thinsp;14 years, males represented most of this population accounting for 77.5% of the included patients.\u003c/p\u003e \u003cp\u003eAll patients underwent a preoperative non-enhanced abdominal CT scan as a part of the preoperative planning. Measurements were done by manual delineation of the visceral fat as well as subcutaneous fat on every axial slice along 3rd lumbar vertebral body (L3) using 3D reconstructed images. Patients were followed for 30 days for detection of early post-operative complications including surgical site infection, seroma and venous thromboembolism. Clinical and imaging data of the complicated cases were collected.\u003c/p\u003e \u003cp\u003eIn our study, the incidence of early (30 day) postoperative complications was (28.2%), the most frequent complication was SSI (n\u0026thinsp;=\u0026thinsp;18) followed by, surgical site hematoma (n\u0026thinsp;=\u0026thinsp;3) then cutaneous sinus tract (n\u0026thinsp;=\u0026thinsp;2)\u003c/p\u003e \u003cp\u003eIn agreement with (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) which found that (26%) of total included patients developed a postoperative complication following Incisional Hernia Repair in Abdominal Transplant Population within the first 30 days.\u003c/p\u003e \u003cp\u003eIn the present study we found that visceral fat is a strong predictor of postoperative complications following herniplasty while it is the only predictor of postoperative complications following abdominal wall reconstruction surgeries using cutoff value 125 cm\u003csup\u003e3\u003c/sup\u003e with sensitivity 79%, while specificity 65% in hernioplasty as well as abdominal wall reconstruction surgeries with cutoff value 445 cm3 with sensitivity 81.3%, and while specificity 80%, respectively.\u003c/p\u003e \u003cp\u003eConcordant with (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e), that demonstrated positive association between increased VFV development of SSO after AWR.\u003c/p\u003e \u003cp\u003eThese results are also matched with (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) reported that visceral obesity (VO) to be superior to BMI in the prediction of complications after laparoscopic gastrectomy.\u003c/p\u003e \u003cp\u003eAnd also with (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) which found that visceral obesity is associated with worse outcomes after surgery for pancreatic, indicating that VO may be an important clinical parameter in the preoperative assessment of several types of surgery.\u003c/p\u003e \u003cp\u003eIn the present study we found that complications in the hernioplasty groups was more prevalent among hypertensive patients (p 0.031), incisional hernias (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) previous hernias (p 0.031), and previous abdominal surgeries (p 0.002). While In abdominal wall reconstruction group we detected that complications was more prevalent among diabetes, hypertension, and smoker patients ,also incisional hernias, previous hernia and previous abdominal surgeries p values(\u0026lt;\u0026thinsp;0.001) (0.002), (\u0026lt;\u0026thinsp;0.001), (0.024) ,( 0.014) and (0.004) respectively.\u003c/p\u003e \u003cp\u003eIn concordance with (Cheema et al., 2021) which reported that history of diabetes and open abdomen are associated with SSO/SSIs, while hypertension is associated with recurrence in abdominal organ transplant patients. This is consistent with prior literature that patient selection plays an important role in hernia surgery.\u003c/p\u003e \u003cp\u003eAlso in agreement with (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) which found that a significant relationship between diabetes mellitus and smoking and the occurrence of complications in patients with incisional hernia repair\u003c/p\u003e \u003cp\u003eOur results demonstrated that no association between BMI and occurrence of early postoperative complications following hernioplasty\u0026ndash; probably due to low BMI among the included participants. In acceptance with (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) which demonstrated that there is no such association between BMI and occurrence of post-operative complications or hernia recurrence following abdominal wall surgeries ( AWR)\u003c/p\u003e \u003cp\u003eMismatched with (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) which concluded (BMI)\u0026thinsp;\u0026gt;\u0026thinsp;35 kg/m2, was associated with surgical site occurrence / infection (SSO/I) (P\u0026thinsp;\u0026lt;\u0026thinsp;.05)\u003c/p\u003e \u003cp\u003eOur study also found that the defect size of abdominal wall hernia, can significantly predict postoperative complications following herniopasty using cutoff value 2.9, with sensitivity 100% and specificity 79%.\u003c/p\u003e \u003cp\u003eIn agreement (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) which reported that defect width larger than 10 cm and reoperation within 90 days were factors independently associated with operation for hernia recurrence following incisional hernia repair, as well as (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) which found a significant relationship between defect size and the occurrence of complications in patients with incisional hernia repair.\u003c/p\u003e \u003cp\u003eWe detected that subcutaneous fat contents can also be used as a predictor postoperative complications following hernioplasty using cutoff value 301 cm3 with sensitivity 73.7%, while specificity 65%.\u003c/p\u003e \u003cp\u003eIn agreement with (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) which revealed subcutaneous fat volume per 1000 cm3 (p\u0026thinsp;=\u0026thinsp;0.034, OR\u0026thinsp;=\u0026thinsp;0.26) was significant predictor of SSI following complex ventral hernia repair.\u003c/p\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eLimitations of this study\u003c/h2\u003e \u003cp\u003eFirst, our study has some limits such as being a small study cohort, done at single-institution. Second, we only had partial follow-up data for a short time; therefore, long-term outcomes, such as hernia recurrence, could not be determined. Also, the small sample size, which may have caused selection bias. Furthermore the Limited area of measurement of body fat volume, along L3 vertebral body (due to lack of automated protocols in our institute), which is sometimes affected with structural pathology (i.e.: fracture). Finally, relative inaccessible some of intra-operative and post-operative recovery data as well as Lack of documentation in our institution.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eWe concluded that visceral fat volume (VFV) was significantly associated with postoperative complication following hernioplasty operation. This study suggests VFV as a risk assessment tool for patients undergoing hernioplasty.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAWR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAbdominal wall reconstruction surgery\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBMI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBody mass index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eComputed tomography\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eIncisional hernia\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eL3\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003e3rd lumbar vertebra\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMSCT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMulti-slice computed tomography\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eROI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eregion of interest\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSSI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSurgical site infection\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSSO\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSurgical site occurrence\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eVFA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eVisceral fat area\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eVFV\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eVisceral fat volume\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eVO\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003evisceral obesity\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003enot applicable (no funding)\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eo M.S.A Put the idea of the study. CT assessment and performed the statistical analysis o I.H.A Participated in the study design and CT assessmento M.S data collection and clinical assessment of the patients. o A.S.H Editor of the manuscript. Participation in the study design.o All authors read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAquina, C.T., Rickles, A.S., Probst, C.P., Kelly, K.N., Deeb, A.P., Monson, J.R., Fleming, F.J. and Muscle and Adiposity Research Consortium, 2015. Visceral obesity, not elevated BMI, is strongly associated with incisional hernia after colorectal surgery. Diseases of the Colon \u0026amp; Rectum, 58(2), pp.220\u0026ndash;227.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBaastrup, N.N., Jensen, K.K., Christensen, J.K. and Jorgensen, L.N., 2022. Visceral obesity is a predictor of surgical site occurrence and hernia recurrence after open abdominal wall reconstruction. Hernia, pp.1\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eC Cheema, F., Andacoglu, O., Huang, L.C., Phillips, S.E. and Malcher, F., 2021, March. Risk factors for surgical site occurrence or infection and recurrence after incisional hernia repair in abdominal transplant population. In Transplantation proceedings (Vol. 53, No. 2, pp. 762\u0026ndash;767). Elsevier.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDu, Y., Karvellas, C.J., Baracos, V., Williams, D.C., Khadaroo, R.G. and Group, E.S.A., 2014. Sarcopenia is a predictor of outcomes in very elderly patients undergoing emergency surgery. Surgery, 156(3), pp.521\u0026ndash;527.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHenriksen, N.A., Friis-Andersen, H., Jorgensen, L.N. and Helgstrand, F., 2021. Open versus laparoscopic incisional hernia repair: nationwide database study. BJS open, 5(1), p.zraa010.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eImai, Y., Lee, S.W., Kawai, M., Tashiro, K., Kawashima, S., Tanaka, R., Honda, K., Matsuo, K. and Uchiyama, K., 2022. Visceral fat area is a better indicator of surgical outcomes after laparoscopic gastrectomy for cancer than the body mass index: a propensity score-matched analysis. Surgical Endoscopy, 36(5), pp.3285\u0026ndash;3297.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJuvany, M., Hoyuela, C., Carvajal, F., Trias, M., Martrat, A. and Ardid, J., 2018. Long-term follow-up (at 5 years) of midline incisional hernia repairs using a primary closure and prosthetic onlay technique: recurrence and quality of life. Hernia, 22, pp.319\u0026ndash;324.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhansa, I. and Janis, J.E., 2019. The 4 principles of complex abdominal wall reconstruction. Plastic and Reconstructive Surgery Global Open, 7(12).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKokotovic, D., Bisgaard, T. and Helgstrand, F., 2016. Long-term recurrence and complications associated with elective incisional hernia repair. Jama, 316(15), pp.1575\u0026ndash;1582.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLin, H.J., Spoerke, N., Deveney, C. and Martindale, R., 2009. Reconstruction of complex abdominal wall hernias using acellular human dermal matrix: a single institution experience. The American journal of surgery, 197(5), pp.599-603.5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOkumura, S., Kaido, T., Hamaguchi, Y., Kobayashi, A., Shirai, H., Yao, S., Yagi, S., Kamo, N., Hatano, E., Okajima, H. and Takaori, K., 2017. Visceral adiposity and sarcopenic visceral obesity are associated with poor prognosis after resection of pancreatic cancer. Annals of Surgical Oncology, 24, pp.3732\u0026ndash;3740.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePark, J.W., Chang, S.Y., Lim, J.S., Park, S.J., Park, J.J., Cheon, J.H., Kim, W.H. and Kim, T.I., 2022. Impact of visceral fat on survival and metastasis of stage III colorectal cancer. Gut and liver, 16(1), p.53.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRana, K.V., Singh, G., Deshpande, N.A., Bharathan, V.K. and Sridharan, S., 2013. Postoperative complications of mesh hernioplasty for incisional hernia repair and factors affecting the occurrence of complications. Medical Journal of Dr. DY Patil University, 6(1), pp.25\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSaravana-Bawan, B., Goplen, M., Alghamdi, M. and Khadaroo, R.G., 2021. The relationship between visceral obesity and post-operative complications: a meta-analysis. Journal of Surgical Research, 267, pp.71\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVerduin WM, Warps AK, van den Helder R, Doodeman HJ, Houdijk APJ, Fat IN et al (2021) Visceral fat and anastomotic leakage after colon cancer resection. Dis Colon Rectum 64(2):163\u0026ndash;170\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWinters, H., Knaapen, L., Buyne, O.R., Hummelink, S., Ulrich, D.J.O., Van Goor, H., Van Geffen, E. and Slater, N.J., 2019. Pre-operative CT scan measurements for predicting complications in patients undergoing complex ventral hernia repair using the component separation technique. Hernia, 23, pp.347\u0026ndash;354.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYamamoto, M., Takakura, Y., Ikeda, S., Itamoto, T., Urushihara, T. and Egi, H., 2018. Visceral obesity is a significant risk factor for incisional hernia after laparoscopic colorectal surgery: A single-center review. Asian Journal of Endoscopic Surgery, 11(4), pp.373\u0026ndash;377\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYang, S.J., Li, H.R., Zhang, W.H., Liu, K., Zhang, D.Y., Sun, L.F., Chen, X.L., Zhao, L.Y., Chen, X.Z., Yang, K. and Chen, Z.X., 2020. Visceral fat area (VFA) superior to BMI for predicting postoperative complications after radical gastrectomy: a prospective cohort study. Journal of Gastrointestinal Surgery, 24, pp.1298\u0026ndash;1306.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":true,"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":"Obesity, BMI, Visceral Fat Volume, Post-Operative Complications, Hernioplasty","lastPublishedDoi":"10.21203/rs.3.rs-5286881/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5286881/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eIncreased risk of wound healing complications following abdominal wall procedures may be associated with obesity and elevated body mass index (BMI).Our study's objectives are to assess the influence of visceral fat volume (VFV) on 30-day post-operative complications after hernioplasty procedure.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAt follow-up, 28.2% of patients had developed postoperative complications. The most frequent complication was surgical site infection (SSI) (25.4%) followed by, surgical site hematoma (4.2%) then cutaneous sinus tract (2.8%).Sensitivity analysis showed that defect size, visceral fat volume, and subcutaneous fat volume can significantly predict postoperative complications with cut-off values 2.9 cm, 125 cm\u003csup\u003e3\u003c/sup\u003e and 301 cm\u003csup\u003e3\u003c/sup\u003e with sensitivity 100%, 79%, 73.7% and specificity 79%, 65%, and 65% respectively.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eVisceral fat volume (VFV) was significantly associated with postoperative complication following hernioplasty operation. This study suggests VFV as a risk assessment tool for patients undergoing hernioplasty.\u003c/p\u003e","manuscriptTitle":"CT Assessment of the Visceral Fat as a Predictor of Early Post-Operative Complications after Hernioplasty","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-15 11:23:45","doi":"10.21203/rs.3.rs-5286881/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":"a1a20c8a-5f31-48a3-b613-c55c14a4104f","owner":[],"postedDate":"November 15th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-08-25T16:40:40+00:00","versionOfRecord":{"articleIdentity":"rs-5286881","link":"https://doi.org/10.1186/s43055-025-01558-2","journal":{"identity":"egyptian-journal-of-radiology-and-nuclear-medicine","isVorOnly":false,"title":"Egyptian Journal of Radiology and Nuclear Medicine"},"publishedOn":"2025-08-18 16:29:42","publishedOnDateReadable":"August 18th, 2025"},"versionCreatedAt":"2024-11-15 11:23:45","video":"","vorDoi":"10.1186/s43055-025-01558-2","vorDoiUrl":"https://doi.org/10.1186/s43055-025-01558-2","workflowStages":[]},"version":"v1","identity":"rs-5286881","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5286881","identity":"rs-5286881","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}