High lymphocyte count as a significant risk factor for incisional hernia after laparoscopic colorectal surgery

Abstract

Abstract Background In the era of laparoscopic surgery, incisional hernia (IH) is still one of the common problems after colorectal surgery. Various risk factors for IH have been evaluated to reduce the incidence, but the impact of nutrition for IH has not been well discussed. The aim of this study is to evaluate the relation between the nutrition status and the development of IH after laparoscopic colorectal surgery. Methods We retrospectively evaluated 342 colorectal cancer patients undergoing laparoscopic colorectomy between January 2012 and December 2018. Postoperative computed tomography was used to diagnose the IH. Patient characteristics including preoperative albumin and lymphocyte counts were evaluated for the risk of development of IH. Further investigations were added about the impact of nutrition status on development of IH in each of BMI under and over 25.0 kg/m2. Results IH was observed in 37 patients (10.8%) with median follow-up period of 48.5 months. Female (OR = 3.43, p < 0.01), BMI ≥ 25 kg/m2 (OR = 2.92, p < 0.01), lymphocyte count ≥ 1798/µl (OR = 3.37, p < 0.01), and operative time ≥ 254 min (OR = 3.90, p < 0.01) had statistically significant relation to IH in multivariate analysis. Low albumin was related to IH in BMI ≥ 25 kg/m2 (p = 0.02), but was not in BMI < 25 kg/m2 (p = 0.21). On the other hand, high lymphocyte count was related to IH regardless of BMI (BMI ≥ 25 kg/m2: p = 0.01, BMI < 25 kg/m2: p = 0.04). Conclusions The high preoperative lymphocyte count is independent risk factor for IH, whereas low albumin has limitation to predict IH.