Incisional Hernia after Pancreaticoduodenectomy: A Systematic Review and Meta-Analysis of Incidence and Risk Factors.
Maria Fernanda Andrade da Silva, Maria Clara Morais, Gabriele Lech et al.
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In 30 seconds
This systematic review and meta-analysis assessed incisional hernia incidence and associated risk factors after pancreaticoduodenectomy (PD). Six studies including 1929 patients were analysed using a random-effects model. The pooled incidence after open PD was 6% (95% CI: 2%-15%), with substantial heterogeneity (I 2 = 94%). Factors associated with hernia included obesity, preoperative hypoalbuminemia, chronic obstructive pulmonary disease, elevated preoperative CRP, postoperative fascial dehiscence, and wound infection. The findings describe associations and do not establish that these factors cause hernia.
Key findings
- Pooled incisional hernia incidence after open PD was 6% (95% CI: 2%-15%); heterogeneity was substantial (I 2 = 94%).
- BMI ≥ 30 kg/m 2 was associated with hernia (OR range: 1.67-2.6), as was preoperative hypoalbuminemia (OR 3.4; 95% CI: 1.2-9.4).
- Wound infection was associated with hernia (OR 2.9; 95% CI: 1.8-4.6); postoperative fascial dehiscence was also associated (HR 14.1; 95% CI: 1.10-180.4).
- Chronic obstructive pulmonary disease (HR 24.4; 95% CI: 1.6-391.9) and elevated preoperative CRP (HR 11.4; 95% CI: 1.2-103.1) were associated with hernia.
Why it matters
Incisional hernia is a relevant postoperative complication after PD, and this synthesis quantifies its reported incidence while identifying patient and wound-related factors associated with it. The wide confidence intervals and substantial heterogeneity mean estimates should be interpreted cautiously, but the findings can help frame risk assessment and highlight areas for further study.
What to keep in mind
Only six studies contributed, and incidence estimates showed substantial heterogeneity (I 2 = 94%). The reported risk factors are associations and do not establish causality.