Incidence and risk factors for incisional hernia after partial liver resection via an inverted L-incision: a retrospective single-centre cohort study

Abstract Background Incisional hernias are a relevant complication after abdominal surgery, but data on their occurrence after open liver resection, particularly via inverted L-incision, are limited. Methods We conducted a retrospective single-centre cohort study including 231 patients, who underwent open liver resection with an inverted L-incision at Goethe University Frankfurt between December 2015 and December 2020. The primary endpoint was the incidence of incisional hernias, confirmed clinically or radiologically. Secondary endpoints included the identification of potential risk factors. Time-to-event analysis was performed using the Kaplan–Meier method with follow-up of up to five years. Results The cohort comprised 59.7% men and 40.3% women with a mean age of 60.3 years (range 20–87). Hepatocellular carcinoma (33.8%) and cholangiocarcinoma (30.3%) were the most common indications, and major resections were performed in 44.6% of cases. Overall, 28 patients (12.1%) developed an incisional hernia during follow-up, 20 of which occurred within the first postoperative year (8.7%). Kaplan–Meier analysis estimated the cumulative incidence of incisional hernia to be 18% at 5 years. Most hernias occurred along the midline (85.7%). In the multivariable analysis, no independent risk factors for incisional hernia could be identified. Conclusion Incisional hernia represents a relevant long-term complication after open liver resection via inverted L-incision. The cumulative incidence increased over time, reaching approximately 18% at five years, suggesting that structured follow-up may be warranted. Future prospective multicentre studies with longer follow-up are required to further clarify risk factors and evaluate preventive strategies. Trial registration Not applicable.