Study Examines Incisional Hernia Risk After CRS/HIPEC for Colorectal and Appendiceal Cancers
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Argın, V., Sunar, A.O., Bezir, N. et al. Incidence and risk factors of incisional hernia after CRS and HIPEC for colorectal-appendiceal peritoneal malignancies: a retrospective cohort study. BMC Surg (2026). https://doi.org/10.1186/s12893-026-04106-5. Published: BMC Surgery (2026, Article in Press)
Patients undergoing cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) often ask what long-term complications they should be aware of after treatment. A new study examined one of the most common late complications—incisional hernias—to better understand how often they occur and which patients may be at the greatest risk.
What is an incisional hernia?
An incisional hernia occurs when tissue or part of the intestine pushes through a weakened area of the abdominal wall where a surgical incision was made. Because CRS/HIPEC requires a large midline incision and extensive abdominal surgery, patients may have a higher risk of developing this complication than those undergoing less extensive operations. Incisional hernias can cause discomfort, a visible bulge, pain, and, in some cases, require another surgery for repair.
What did the researchers study?
Researchers reviewed the records of 147 patients treated with CRS/HIPEC for colorectal cancer or appendiceal cancers (including pseudomyxoma peritonei) at a single specialized center between 2018 and 2024.
Patients were followed for at least 18 months after surgery, with an average follow-up of about 31 months, to determine who developed an incisional hernia and what factors were associated with that risk.
What did they find?
During follow-up:
56.5% of patients developed an incisional hernia.
Every hernia occurred along the midline surgical incision used during CRS/HIPEC.
Two factors significantly increased the likelihood of developing an incisional hernia:
A history of previous open abdominal surgery
A history of a prior abdominal wall (incisional) hernia
Interestingly, several factors that are commonly associated with hernias were not linked to an increased risk in this study, including:
Age
Sex
Body mass index (BMI)
Diabetes
Smoking history
Peritoneal Cancer Index (PCI)
Length of surgery
Peritonectomy
Surgical wound infection
Why are these findings important?
Many patients who undergo CRS/HIPEC have already had one or more abdominal surgeries before being referred to a specialized center. This study suggests that previous surgery may weaken the abdominal wall, making patients more susceptible to developing a hernia after CRS/HIPEC.
Patients who have already experienced an incisional hernia before CRS/HIPEC appear to be at particularly high risk of developing another one. Knowing this before surgery may help surgeons identify patients who could benefit from closer monitoring or preventive strategies during abdominal wall closure.
What does this mean for patients?
This study does not suggest that patients should avoid CRS/HIPEC if they are appropriate candidates. Instead, it highlights the importance of discussing your personal surgical history with your treatment team.
Before surgery, you may want to ask:
Have I had previous abdominal surgeries that increase my hernia risk?
Have I ever had an incisional or abdominal wall hernia?
What techniques will be used to strengthen my abdominal wall during closure?
What symptoms should I watch for after surgery that might suggest a hernia?
If I'm at higher risk, will my follow-up include additional monitoring?
Important limitations
Although the findings are valuable, this was a single-center retrospective study, meaning researchers looked back at existing medical records rather than following patients prospectively.
The reported hernia rate (56.5%) was considerably higher than rates reported in previous studies (generally 7%–17%). The authors note this may reflect differences in surgical techniques, patient selection, follow-up methods, or how hernias were diagnosed. Larger, prospective studies are needed to better understand the true incidence and determine whether preventive measures—such as different abdominal closure techniques or prophylactic mesh in selected high-risk patients—can reduce this complication.
Bottom Line
Incisional hernias are an important long-term complication after CRS/HIPEC. This study suggests that patients with a history of previous open abdominal surgery or a prior incisional hernia have the highest risk. Understanding these risk factors allows patients and surgeons to have informed conversations about recovery, long-term follow-up, and strategies that may help reduce future complications.
