Risk Factors for Wound Complications and Hernia Recurrence in Abdominal Wall Reconstruction: A Single-Institution Retrospective Study.

Abstract

INTRODUCTION: Incisional hernia (IH) remains a frequent and challenging postoperative complication, often requiring complex abdominal wall reconstruction (AWR). This study aimed to evaluate the outcomes of AWR and identify risk factors for wound complications and hernia recurrence at a district general hospital. METHODS: A retrospective cohort study was conducted at Queen's Hospital Burton, including 42 patients who underwent elective midline AWR between June 2017 and December 2023. Data on patient demographics, hernia characteristics, operative details, and postoperative outcomes were collected. Primary outcomes were hernia recurrence and wound complications. Secondary outcomes included hospital length of stay, postoperative ileus, fistula formation, and reoperation. Univariate statistical analysis was performed to identify predictors of wound complications; analysis for risk factors for recurrence was not feasible due to the low event rate. RESULTS: The mean patient age was 60.4 ± 12.5 years, with a mean BMI of 32.4 ± 5.0 kg/m². The most common repair technique was Rives-Stoppa, used in 28 (66%) patients. Hernia recurrence occurred in two (4.8%) patients, while wound complications were observed in 21 (50%) patients, predominantly seromas, which were noted in 12 (28.5%) patients. A BMI >35 kg/m² was significantly associated with wound complications (p=0.016). Other factors, including age, diabetes, smoking status, and hernia type, were not statistically significant predictors. The mean hospital stay was 5.4 ± 3.15 days, with a single postoperative mortality (2.4%). Conclusion: AWR using the Rives-Stoppa technique with retrorectus mesh placement resulted in low recurrence rates and acceptable morbidity, although postoperative wound complications occurred in half of the patients. High BMI was a significant predictor of wound complications. These findings underscore the importance of tailored surgical planning and preoperative optimization in high-risk patients undergoing complex ventral hernia repair.