Incisional Hernia in Gynecologic Oncology Patients: A 10-Year Study MASSIMO FRANCHI, MD, FABIO GHEZZI, MD, MARCO BUTTARELLI, MD, SAVERIO TATEO, MD, DEBORA BALESTRERI, MD, AND PIERFRANCESCO BOLIS, MD Objective: To evaluate the independent contribution of clin- ical and constitutional factors in the development of early and late incisional hernias in women undergoing surgery for uterine cancer. Methods: Over 10 years, patients undergoing extended abdominal hysterectomy for cervical or endometrial malig- nancies through a vertical incision were followed for the identification of incisional hernias. Logistic regression and survival analyses were used for statistics. Results: Four hundred fifty-five women were included in the study, 77 of whom (16.9%) developed incisional hernias. The median (range) body mass index was higher in women who developed an incisional hernia than in those who did not (28 [19 – 44] kg/m 2 versus 24 [16 – 41] kg/m 2 ; P < .01). The frequencies of diabetes (14.3% versus 4.8%; P < .01), wound sepsis (10.4% versus 1.3%; P < .05), and fascial closure with interrupted sutures (70.1% versus 55.6%; P < .05) were significantly higher in women with incisional hernia than in those without. Multiple logistic regression revealed that, after adjustment for confounding variables, the only factors associated with incisional hernia formation within 1 year from the operation were body mass index above 27 kg/m 2 (odds ratio [OR] 3.68; 95% confidence interval [CI] 1.38, 9.81; P < .01) and wound infection (OR 5.05; 95% CI 1.39, 18.37; P < .01), whereas the factors associated with incisional hernia formation at least 3 years after surgery were diabetes (OR 6.68; 95% CI 2.02, 22; P < .01) and wound infection (OR 8.55; 95% CI 1.54, 47.5; P < .01). For hernia developing after 5 years (OR 8.32; 95% CI 1.41, 55.65; P < .05) and 8 years (OR 49.52; 95% CI 2.72, 907.14; P < .01), the only significant association was found with diabetes. Conclusion: Late incisional hernia formation does not depend on conditions present at the time of operation or on surgical technique. Other factors such as diabetes seem to play an important role in the development of late incisional hernia. (Obstet Gynecol 2001;97:696 –700. © 2001 by The American College of Obstetricians and Gynecologists.) Incisional hernia remains one of the most important long-term sequelae after laparotomy. 1,2 Although sev- eral conditions 3,4 have been found to be associated with the development of incisional hernia, the occurrence of this complication in gynecologic oncology patients has not been fully investigated. Colombo et al 5 reported that the occurrence of inci- sional hernia within 3 years after midline abdominal incision for gynecologic malignancies was strongly as- sociated with obesity, postmenopausal status, and an- esthesiologic risk factors, but not with closure technique (continuous versus interrupted suture). Similarly, Sut- ton and Morgan 6 found that abdominal closures in gynecologic patients with either a running, looped, monofilament polybutester suture or Smead-Jones in- terrupted suture were comparable in their likelihood of wound dehiscence. Conversely, in patients undergoing laparotomy for nongynecologic diseases, a relation has been described between the development of incisional hernia and both the suture material used for abdominal closure 7,8 and the suture technique. 9,10 Moreover, early wound infec- tion, 11 length of the abdominal incision, 12 chest infec- tion, 13 and male gender 13 were found to be clearly associated with the subsequent formation of an inci- sional hernia. In most investigations, patients were followed up for incisional hernia only until 1 year after the opera- tion. 7,8,13,14 However, Mudge and Hughes 15 noted that in patients undergoing elective major abdominal sur- gery of the gastrointestinal tract, biliary tree, or colon, the incidences of incisional hernia after 1 and 3 years from the operation were 44% and 79%, respectively. The purpose of our study was to explore the factors associ- ated with the formation of early and late incisional hernia in patients undergoing surgery for uterine ma- lignancies during a 10-year period. From the Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy. 696 0029-7844/01/$20.00 Obstetrics & Gynecology PII S0029-7844(01)01192-9