Incidence of incisional hernia after closure of burst abdomen - a single-center, retrospective cohort study

Introduction Burst abdomen is a severe postoperative complication associated with high morbidity and a substantial risk of subsequent incisional hernia. Evidence regarding the optimal fascial closure technique following surgical repair remains limited. Methods This retrospective single-center cohort study included adult patients undergoing surgical repair of burst abdomen after midline laparotomy between 2017 and 2024. Patients with complete fascial closure and at least 30 days of follow-up were included. The primary objective was the development of incisional hernia within 6 years after the operation. Two closure strategies, interrupted polyglactin 910 and predominantly continuous polydioxanone, were compared in an exploratory analysis. Univariable and multivariable analyses were performed to identify independent risk factors. Death was treated as a competing event in a sensitivity analysis. Results A total of 104 patients were included. Median follow-up was 18.1 months. The cumulative incidence of incisional hernia was 26.3% at 12 months, 39.6% at 24 months and 45.1% at 36 months (24.0%, 34.7% and 38.9% when death was treated as a competing event). Hernia incidence did not differ significantly between interrupted polyglactin 910 closure (n = 85) and polydioxanone closure (n = 19, hazard ratio 1.21, 95% CI 0.49–2.97). Recurrent burst abdomen was more frequent after polydioxanone closure (26.3% versus 5.9%, p = 0.02). Increasing age was associated with incisional hernia formation (hazard ratio 1.05 per year, 95% CI 1.02–1.08, p = 0.003), consistently across alternative models. Its effect was not constant over time and was mainly apparent after the first year. Discussion Almost half of the patients developed an incisional hernia within 3 years of burst abdomen repair. The two closure strategies did not differ significantly in hernia incidence, but the small polydioxanone group and the confounding of suture material and technique preclude conclusions on the optimal closure. Increasing age was associated with abdominal wall failure. Prospective studies with a standardized and documented closure technique are needed to define optimal reconstructive strategies in this high-risk population.