For a study, researchers examined the most important morphometric aspects of preoperative computed tomography (CT) imaging predictive of incisional hernia (IH) formation after abdominal surgery. IH affects 13% of patients undergoing abdominal surgery and profoundly affects all surgical specialties operating in the thoracic and abdominal regions. IH is connected with high healthcare expenses and impairment; however, its pathogenesis is little understood. Clinical and demographic information on a cohort of patients (n=21,501) who had colorectal surgery was collected, with IH serving as the primary outcome. Case-control matched pairs were used to generate 2 datasets for measuring and assessing feature measurement and classification. Preoperative CT scans of the abdomen and pelvis were de-identified, and morphometric linear and volumetric measures were retrieved as features. A multivariate Pearson test was used to analyze the degree of similarity between variables. A 2 -tailed paired t-testing was used to assess each feature’s discriminatory power between classes. Using a support vector machine, investigators evaluated the characteristics’ prediction accuracy singly and in combination. A total of 212 patients were evaluated (106 matched pairs). About 21 of the 117 features used to create the model could distinguish between IH and non-IH patients. These characteristics are broken down into 3 primary pathophysiological areas: Increased visceral volume, weakened abdominal and pelvic muscles, and anatomical enlargement of the rectus complex are the 3 main effects of being overweight. The best 3 features out of a total of 117 showed individual prediction accuracy ranging from 0.69 to 0.78. The hernia was linked to changes in 3 distinct morphometric domains detectable on routine preoperative CT imaging: rectus complex widening, increased visceral volume, and body wall skeletal muscle atrophy. This study sheds light on a novel pathophysiologic mechanism for IH formation characterized by elevated intra-abdominal pressure and weakening of the rectus complex and abdominopelvic skeletal muscles.