Subcutaneous and visceral adipose tissue in patients with primary and recurrent incisional hernia

Qandeel, H. and Chew, C. and Young, D. and O’Dwyer, P. J. (2021) Subcutaneous and visceral adipose tissue in patients with primary and recurrent incisional hernia. Hernia. ISSN 1248-9204 (

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Purpose: Visceral obesity rather than body mass index has been reported to be associated with a higher incidence of incisional hernias. The aim of this study was to examine the relationship between CT measured adipose tissue and muscle in primary and recurrent incisional hernia. Methods: Patients with a 'Primary' or 'Recurrent incisional hernia' were obtained from a prospective cohort of patients who were being assessed for incisional hernia repair over a 2-year period. Computerised tomography (CT)-images were analysed using NIH Image-J software to quantify adipose tissue and skeletal muscle cross-sectional areas at the level of lumber vertebra 3/4 using standard Hounsfield units. To test inter-observer 'absolute agreement', each parameter was measured independently by two investigators and reliability analysis performed. Results: Thirty-six patients were included in the study: 15 had a Primary while 21 had a Recurrent incisional hernia. Both groups had similar baseline characteristics. Reliability analysis for CT-measured areas showed very high interclass correlation coefficient (ICC) between observers. Patients in the recurrent group had significantly greater subcutaneous adipose tissue (SAT) [median = 321.9cm 2 vs 230.9cm 2, p = 0.04] and visceral adipose tissue (VAT) [median = 221.1cm 2 vs 146.8cm 2, p = 0.03] than those in the primary group. There was no difference in skeletal muscle areas for right [median = 2.8cm 2 vs 2.9cm 2] and left [median = 3.7cm 2 vs 4.1cm 2] rectus muscles between groups. Conclusion: Our study shows that patients with a recurrent incisional hernia have significantly more subcutaneous and visceral adipose tissue than those with a primary incisional hernia. Further studies in this area are required if we are to reduce the burden of recurrent hernia following repair of a primary incisional hernia.