HPB P50 A comparison of layered vs mass closure in development of incisional hernia following Kocher’s incision for open cholecystectomy, a retrospective analysis

Abstract Background Incisional hernias are a common complication of abdominal surgery. Open cholecystectomy procedures predispose to development of incisional hernias. Studies have shown rates of incisional hernias in visceral abdominal surgery to be 12.6% at one year and 22.4% at 3 years [1]. Several techniques have been developed to reduce rates of incisional hernia, namely abdominal wall closure in layers rather than mass closure. The purpose of our study is to evaluate whether layered closure is superior in preventing incisional hernias compared to mass closure. Methods The study reviewed retrospective data on 694 cholecystectomies at Southport or Ormskirk NHS Trust between 2018-23. Of these cases, 104 underwent open procedures. Operation notes and follow up were accessed electronically and analysed. Patients were also contacted by telephone to further establish whether they have developed incisional hernias and discuss other complications following surgery. The primary objective was to compare hernia rates between mass and layered closure. Secondary objectives were to establish hernia incidence in relation to gender, age, BMI, and elective vs emergency surgery. Results Of the data analysed, there was an equal proportion of male and female patients. Median age of patients was 62. Median BMI of all patients was 29 and median BMI of those developing hernias was 37. 80.8% of open cholecystectomies were elective procedures and 19.2% were emergency procedures. Infection rate was found to be 3.8%, and 30-day mortality was 1.9%. The mean rate of incisional hernia was 7.7% with mean rates of mass and layered closure at 2.7% and 11.1%, respectively. Fisher’s exact test showed that there was no statistical significance in closure method on hernia development. Conclusions We found no statistical significance in incisional hernia development between mass and layered closure in open cholecystectomies. No statistical significance was seen in hernia development with relation to age, gender and elective vs emergency surgery, however greater BMI was found to be statistically significant in increasing risk of hernia development. Larger, prospective multi-centre data are needed to further evaluate these results and aid surgeons in choosing an optimal closure technique in the future.