Effect of Monofilament Sutures on Incisional Hernia After Laparoscopic Colorectal Surgery: A Focus on Patients With Umbilical Hernia

Background/Aim: Incisional hernia (IH) is a common complication of laparoscopic colorectal surgery and is associated with risk factors such as obesity, diabetes, and smoking. Umbilical hernia is recognized as a strong predictor of IH; however, the effect of suture type on the occurrence of IH remains unclear. We aimed to evaluate whether the use of monofilament sutures reduced the incidence of IH, particularly in patients with umbilical hernias.

Patients and Methods: This retrospective cohort study included 223 patients who underwent laparoscopic colorectal surgery between January 2013 and December 2022. Patients were divided into two groups based on the type of suture used: Monofilament or multifilament. IH was diagnosed using computed tomography imaging 2 years postoperatively. Univariate and multivariate logistic regression analyses were performed to identify the risk factors for IH.

Results: The overall incidence of IH was 20.7% and 13.6% in the multifilament and monofilament groups, respectively (p=0.217). However, in patients with umbilical hernias, IH was significantly more frequent in the multifilament group (41.5%) than in the monofilament group (17.6%) (p=0.0431). In the multivariate analysis, umbilical hernia (odds ratio=3.4, 95% confidence interval=1.69-6.91; p<0.01), the use of multifilament sutures (odds ratio=3.42, 95% confidence interval=1.59-7.34; p<0.01), and female sex (odds ratio=3.04, 95% confidence interval=1.28-7.27; p=0.012) were identified as independent risk factors for IH. No significant differences in postoperative infection rates were observed between the groups.

Conclusion: The use of monofilament sutures may reduce the risk of IH in patients with umbilical hernias, although they do not eliminate the risk entirely. Umbilical hernia remains a stronger predictor of IH than body mass index. Further technical refinements are required to optimize wound-closure strategies and minimize IH occurrence.