Natural History of Radiologic Incisional Hernia Following Robotic Nephrectomy

Objective: To evaluate the incidence and natural history of radiologic incisional hernia (IH) in patients who underwent robotic partial or radical nephrectomy. Materials and Methods: We retrospectively reviewed the records of patients who underwent robotic partial or radical nephrectomy for kidney tumor in our institution between January 2011 and April 2017. All pre- and postoperative imagings were re-reviewed for detection of IH per Tonouchi classification. Patients who developed hernia were followed up and classified into stable or progressive group. Clinical findings and radiologic features of these patients are reported. Results: A total of 247 patients (169 partial and 78 radical nephrectomies) were included in the study. The incidence of radiologic IH was 27.53%, graded as early-onset (35.3%), late-onset (51.5%), and bowel/fat containing (13.2%). Median time to radiologic IH was 1.7 years. During the follow-up of 68 patients who developed hernia, 33 (48.5%) had progressive and 8 (11.7%) developed clinical hernia. Median time to progression was 1.5 years. On multivariable analysis, adjuvant therapy was an independent predictor for radiologic hernia development (HR 3.23). Pathologic T stage ≥2 and history of open abdominal surgery were also significantly associated with hernia progression (HR 3.93 and 3.47, respectively). Conclusions: Radiologic IH after robotic partial or radical nephrectomy is common. Progression rate is as high as 50% with median time to progression of 1.5 years. Adjuvant therapy is an independent predictor for IH development, whereas higher stage and history of open abdominal surgery are associated with IH progression.