A gynecological perspective on incisional hernia in patients after hysterectomy for benign vs. malignant indications

Aims: The aim of this study is to compare demographic and perioperative data of patients who developed incisional hernia after hysterectomy at Kocaeli University Medical Faculty and to evaluate potential factors contributing to hernia formation. Methods: Retrospective data were analyzed for patients who underwent hysterectomy for benign or malignant reasons and later developed incisional hernia at the same hospital. A total of 63 patients, including 27 with malignancy and 36 with benign conditions, were included. Demographic data such as age, body-mass index (BMI), smoking, incision, surgical site infection (SSI), drain, and duration were assessed. Results: The mean age of the patients was 56.44±9.49 years. No statistically significant differences were found between the two groups regarding age, BMI, comorbidities, smoking, SSI, and drain duration. However, there was a significant difference in the incision, with the Pfannenstiel incision being preferred for benign hysterectomy (p<0.0001). Drain use was significantly more common in malignant cases (p=0.002). Conclusion: Incisional hernia is one of the most common types of ventral hernia. Incisional hernias are most frequently observed in women, especially following gynecological and obstetric surgeries. In our study, benign cases showed a higher incidence of incisional hernia. Obesity is a significant risk factor for hernia. The average BMI in the study was 31.18±5.22, with no significant difference between the groups. The lower midline incision was identified as the most risky incision for hernia development, though most of our patients had a Pfannenstiel incision. Despite treatment, incisional hernia developed in many patients with SSI. SSI was presence in only 28.6% of those who developed hernia in both groups. Smoking causes tissue hypoxia, and the smoking rate among our patients was 39.7%. Modifiable risk factors can be managed or controlled to prevent hernia development