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Periumbilical Transverse Incision for Reducing Incisional Hernia in Laparoscopic Colon Cancer Surgery

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Abstract

Background

Although off-midline incisions (unilateral low transverse or Pfannenstiel incision) have been reported to have a lower incidence of incisional hernia (IH) than periumbilical vertical incision for the purpose of specimen extraction, it is most commonly used in laparoscopic colon cancer surgery because off-midline incisions are associated with the limitation of colon exteriorization. This study aims to investigate the risk of IH after laparoscopic colectomy and compare midline vertical incision versus transverse incision focusing on the incidence of IH.

Methods

Patients who underwent elective laparoscopic colectomy due to colon malignancy from June 2015 to May 2017 were included. All patients had either vertical (n = 429) or muscle splitting periumbilical transverse incisions (n = 125).

Results

Median duration of the follow-up period was 23.6 months, during which IHs occurred in 12.1% patients. The incidence of hernia was significantly lower in the transverse group (3 vs. 64, 2.4% vs. 14.9%, p < 0.001). On multivariate analysis, BMI ≥ 23 [odds ratio (OR) 2.282, 95% confidence interval (CI) 1.245–4.182, p = 0.008], postoperative surgical site infection (OR 3.780, 95% CI 1.969–7.254, p < 0.001) and vertical incision (OR 7.113, 95% CI 2.173–23.287, p < 0.001) were independently related with increased incidence of IH.

Conclusions

A muscle splitting periumbilical transverse incision could significantly reduce the rate of IH in minimally invasive colon cancer surgery.

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Data availability

The data that support the findings of this study are available from the corresponding author, upon reasonable request.

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Authors and Affiliations

  1. Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeonnam, 519-763, Korea

    Chang Hyun Kim, Jaram Lee, Soo Young Lee & Hyeong Rok Kim

  2. Department of Radiology, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Korea

    Suk Hee Heo & Yong Yeon Jeong

Authors
  1. Chang Hyun Kim
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  2. Jaram Lee
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  3. Soo Young Lee
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  4. Suk Hee Heo
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  5. Yong Yeon Jeong
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  6. Hyeong Rok Kim
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Correspondence to Hyeong Rok Kim.

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The authors declare that they have no conflict of interest.

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Ethical approval

This study was performed after institutional review board approval (IRB No. CNUHH-2019-231) in the Chonnam National University Hwasun hospital in Republic of Korea. The research meets the ethical guidelines. The study was also conducted according to the Helsinki Declaration Guidelines.

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This study is a retrospective study, and informed consent was waived with approval of institutional review board.

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Kim, C.H., Lee, J., Lee, S.Y. et al. Periumbilical Transverse Incision for Reducing Incisional Hernia in Laparoscopic Colon Cancer Surgery. World J Surg 46, 916–924 (2022). https://doi.org/10.1007/s00268-021-06319-6

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  • DOI: https://doi.org/10.1007/s00268-021-06319-6

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