Male and female hernia patients often have different surgical history, fat distribution, and medical comorbidities. Female surgical patients seemingly experience worse outcomes after open ventral hernia repair. This study evaluates the impact of sex and the distribution of abdominal adiposity on outcomes after open ventral hernia repair.
A prospective hernia database was queried for patients from 2007 to 2018 with a computed tomography within 1 year of open ventral hernia repair. Three-dimensional volumetric analysis was performed. Demographics, abdominal fat distribution, operative characteristics, and outcomes were evaluated by sex using univariate and multivariate analysis.
A total of 1,178 patients were identified, 57.8% were female. Compared with males, females had higher mean body mass index (34.8 ± 8.5 vs 31.7 ± 6.4 kg/m2, P < .0001), previous abdominal operations (3.3 ± 1.5 vs 2.6 ± 1.3, P < .0001), and preoperative chronic pain (33.5 vs 26.4%, P = .009). There was no difference in history of recurrence, age, steroid use, smoking, diabetes, or hernia volume between sexes (P ≥ .17 all values). Males had larger defects (168.1 ± 148.2 vs 138.8 ± 126.8 cm2, P = .001) and intra-abdominal volume (intra-abdominal fat volume; 6,279 ± 2,614 vs 4,454 ± 2,196 cm3, P < .0001). Females had larger subcutaneous fat volume (subcutaneous fat volume; 7,453 ± 6,600 vs 5,708 ± 3,275 cm3, P < .0001), and ratio of hernia to intra-abdominal volume (hernia volume to intra-abdominal fat volume; 0.33 ± 0.52 vs 0.22 ± 0.42, P < .0001). On univariate analysis, females had higher rates of readmission, wound complication, and intervention for pain after open ventral hernia repair (P ≤ .02 all values). On multivariate analysis, females had shorter duration of stay (–1.36 day, standard error 0.49, P = .006) with higher readmission rate (odd ratio, 1.64; 95% confidence interval, 1.15–2.34).
Female hernia patients in our population are more comorbid, with higher body mass index, thicker subcutaneous fat volume and a higher ratio of hernia volume to intra-abdominal fat volume. These differences are associated with more extensive surgical intervention, such as panniculectomy and higher rates of adverse outcomes after open ventral hernia repair. However, these differences are not fully explained by identified comorbidities and warrant further investigation.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Surgery
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Prevalence and predictors of hernia infection: does gender matter?.Am Surg. 2016; 82: E93-E95
- Nationwide prospective study on readmission after umbilical or epigastric hernia repair.Hernia. 2013; 17: 487-492
- Predictive modeling for chronic pain after ventral hernia repair.Am J Surg. 2016; 212: 501-510
- Female gender is a risk factor for pain, discomfort, and fatigue after laparoscopic groin hernia repair.Hernia. 2013; 17: 321-327
- Laparoscopic versus open hernia repair: outcomes and sociodemographic utilization results from the nationwide inpatient sample.Surg Endosc. 2013; 27: 109-117
- Surgical outcome of mesh and suture repair in primary umbilical hernia: postoperative complications and recurrence.Hernia. 2016; 20: 509-516
- Mortality after groin hernia surgery.Ann Surg. 2007; 245: 656-660
- Primary and incisional ventral hernias are different in terms of patient characteristics and postoperative complications-a prospective cohort study of 4,565 patients.Int J Surg. 2018; 51: 114-119
- Outcomes after emergency versus elective ventral hernia repair: a prospective nationwide study.World J Surg. 2013; 37: 2273-2279
- Lipid and lipoprotein changes after long-term weight reduction: the influence of gender and body fat distribution.J Am Coll Nutr. 1995; 14: 382-386
- The sexual dimorphism of obesity.Mol Cell Endocrinol. 2015; 402: 113-119
- The interplay between fat mass and fat distribution as determinants of the metabolic syndrome is sex-dependent.Metab Syndr Relat Disord. 2017; 15: 337-343
- Obesity increases the odds of acquiring and incarcerating noninguinal abdominal wall hernias.Am Surg. 2012; 78: 1118-1121
- Sexual dimorphisms in genetic loci linked to body fat distribution.Biosci Rep. 2017; 37 (BSR20160184)
- Obesity and abdominal wall reconstruction.Plast Reconstr Surg. 2018; 142: 30S-35S
- Laparoscopic ventral hernia repair: a single center experience.Hernia. 2006; : 10236-10242
- Predicting severe postoperative respiratory complications following abdominal wall reconstruction.Plast Reconstr Surg. 2012; 130: 836-841
- The effect of BMI on outcomes following complex abdominal wall reconstructions.Ann Plast Surg. 2016; 76: S295-S297
- Computed tomographic measurements predict component separation in ventral hernia repair.J Surg Res. 2015; 199: 420-427
- Thickness of subcutaneous fat as a strong risk factor for wound infections in elective colorectal surgery: impact of prediction using preoperative CT.Dig Surg. 2010; 27: 331-335
- Prospective measurements of intra-abdominal volume and pulmonary function after repair of massive ventral hernias with the components separation technique.Ann Surg. 2010; 251: 981-988
- Associations between anxiolytic medications and ventral hernia repair.. 2018; 22: 753-757
- Recurrence and pseudorecurrence after laparoscopic ventral hernia repair: predictors and patient-focused outcomes.Am Surg. 2014; 80: 138-148
- Preoperative pain is the strongest predictor of postoperative pain and diminished quality of life after ventral hernia repair.Am Surg. 2013; 79: 829-836
- Too big to breathe: predictors of respiratory failure and insufficiency after open ventral hernia repair.Surg Endosc. 2019;
- Incisional hernia repair after caesarean section: a population-based study.Aust New Zeal J Obstet Gynaecol. 2015; 55: 170-175
- Adverse events after ventral hernia repair: the vicious cycle of complications.J Am Coll Surg. 2015; 221: 478-485
- Long term follow up for incisional hernia after severe secondary peritonitis-incidence and risk factors.Am J Surg. 2010; 200: 229-234
- Shaping fat distribution: new insights into the molecular determinants of depot- and sex-dependent adipose biology.Obesity. 2015; 23: 1345-1352
- Relationship between regional body fat distribution and diabetes mellitus: 2008 to 2010 Korean National Health and Nutrition Examination Surveys.Diabetes Metab J. 2017; 41: 51
- Indications and outcomes following complex abdominal reconstruction with component separation combined with porcine acellular dermal matrix reinforcement.Ann Plast Surg. 2012; 69: 394-398
Huntington C, Jachthuber CE, Cox TC, et al. Panniculectomy with open ventral hernia repair: a prospective, randomized (by insurance) study. J Am Coll Surg. 221:S117-S118.
- Pre-operative CT scan measurements for predicting complications in patients undergoing complex ventral hernia repair using the component separation technique.Hernia. 2019; 23: 347-354
- What exactly is meant by “loss of domain” for ventral hernia? Systematic review of definitions.World J Surg. 2019; 43: 396-404
- Ventral hernia repair in patients with abdominal loss of domain: an observational study of one institution’s experience.Hernia. 2017; 21: 245-252
Published online: December 26, 2019
Accepted: November 11, 2019
© 2019 Elsevier Inc. All rights reserved.