Umbilical fat is a critical factor in predicting incisional hernia risk after laparoscopic colorectal surgery.

• Cumulative incidence of incisional hernia was 33.6%, with only 2.1% symptomatic cases.
• Umbilical fat increased hernia risk significantly (hazard ratio 6.56).

Preoperative CT to evaluate umbilical fat can help identify high-risk patients.

• Long surgical times and adjuvant chemotherapy also contribute to increased hernia risk.