Clinical Impact of Subcutaneous Fat Area on Incisional Hernia Development Following Laparoscopic Colorectal Cancer Surgery

Introduction Incisional hernia is a common complication experienced by patients who have undergone colorectal surgery. Visceral and subcutaneous fats have been implicated as risk factors; however, only a few studies have evaluated the role of abdominal wall musculature. Therefore, we examined the anatomical features of the intra‐abdominal cavity and abdominal wall to identify risk factors for incisional hernia following laparoscopic colorectal resection. Methods This retrospective study involved 164 patients who underwent laparoscopic colorectal resection for cancer between January 2019 and December 2024 at our institution. Specimens were extracted via a small midline umbilical incision. Patients with prior midline incisions or stomas were excluded. Preoperative computed tomography at the umbilical level was used to measure visceral and subcutaneous fat area using SYNAPSE VINCENT. Clinical, operative, and postoperative data were collected. The diagnosis was established by physical examination or computed tomography during a median follow‐up period of 24 months. Results Sixteen patients (9.8%) developed incisional hernia. In all patients, incisional hernia developed within 18 months postoperatively. Univariate analysis identified female sex, body mass index, and visceral and subcutaneous fat area as significant predictors. Multivariate analysis identified subcutaneous fat area as an independent risk factor ( p = 0.018; OR = 5.839; 95% CI: 1.331–41.452). Conclusion The subcutaneous fat area was independently associated with incisional hernia after laparoscopic colorectal resection. Meticulous fascial closure and tailored surgical strategies are essential in these patients. Furthermore, abdominal wall structure, rather than fat indices alone, should be considered in risk assessment and prevention of incisional hernia.