Outcomes of abdominal wall reconstruction with and without concurrent skin excision: a single-surgeon retrospective cohort study.

Abstract

Aim: The primary objective of this study was to evaluate and compare the clinical outcomes of incisional hernia repairs performed by a single surgeon, with and without concurrent skin excisions. Given the increasing prevalence of incisional hernias and the growing need for comprehensive abdominal wall reconstruction, this study aimed to determine whether the addition of skin excision significantly affects postoperative outcomes, including length of hospital stay (LOS), complication rates, and wound infection incidence. Furthermore, the study explored the influence of patient-related factors such as body mass index (BMI) and hernia size on surgical outcomes.

Methods: A retrospective analysis was conducted on 94 patients who underwent incisional hernia repairs between 2019 and 2023. These patients were divided into two groups: those who underwent hernia repair without skin excision (n = 52, 55%) and those who had skin excision as part of the procedure (n = 42, 45%). Key outcome measures included LOS, postoperative complications, and wound infection rates. Additionally, patients were stratified based on BMI (≥ 30 vs. <30) to assess its impact on surgical outcomes. Statistical analysis was performed using Pearson's chi-square and one-way ANOVA tests, with significance defined as p < 0.05.

Results: The median age of patients in the study cohort was 57 years (range: 24-88 years). Patients who did not undergo skin excision had a significantly shorter LOS compared to those who underwent concurrent skin excision (mean: 2.8 days vs. 6.8 days, p = 0.023). Despite the extended hospitalisation in the skin excision group, overall complication rates were comparable between the two cohorts (34% vs. 31%, p = 0.436). There was no statistically significant difference in wound infection rates between the no-skin-excision and skin-excision groups (23% vs. 16%, p = 0.441). BMI was found to be a significant factor influencing postoperative outcomes. Patients with a BMI of ≥ 30 (n = 10) exhibited a markedly higher incidence of postoperative complications and wound infections (p < 0.001), though BMI did not appear to affect LOS (p = 0.962). Additionally, the size of the hernia was an important determinant of surgical outcomes. Larger hernias (≥ 6 cm) were associated with a longer LOS compared to smaller hernias (mean: 6.4 days vs. 2.8 days, p = 0.051). While there was a trend towards a higher complication rate in larger hernia repairs, the difference did not reach statistical significance.

Conclusion: Patients undergoing concurrent skin excision experienced a longer hospital stay, whereas postoperative complication and wound infection rates were comparable between groups on univariable analysis. However, without multivariable adjustment, these findings should be interpreted as associations rather than evidence of an independent effect of skin excision. Patients with BMI ≥ 30 had higher complication rates, although the small subgroup size limits definitive conclusions. Larger prospective studies are required to clarify these associations and inform clinical practice.