Langenbeck's Archives of Surgery

, Volume 400, Issue 4, pp 505–512 | Cite as

Significant reduction in the incidence of small bowel obstruction and ventral hernia after laparoscopic compared to open segmental colorectal resection

  • Daniel D. KlaristenfeldEmail author
  • Elisabeth C. McLemore
  • Bonnie H. Li
  • Mohammad A. Abbass
  • Maher A. Abbas
Original Article



The aim of this study is to assess the incidence of incisional ventral hernia and small bowel obstruction following laparoscopic and open colorectal resection.


A retrospective review was performed of a large database comprising 13 hospitals, serving 3.6 million patients in Southern California. Patients 18 years and older undergoing elective colorectal resection over a 3-year period were included. The crude incidence rates were calculated, and relative risks of ventral hernia and small bowel obstruction were determined using multivariable proportional hazard modeling.


Four thousand six hundred and thirteen patients underwent 4765 colorectal resections between August 2008 and August 2011. Fifty-nine percent of the cases were performed laparoscopically; the median age was 63 years, and 49 % were males. Colorectal carcinoma (45 %) and diverticulitis (18 %) were the most common indications for surgery. The median follow-up was 2.4 years. Kaplan-Meier estimates of ventral hernia at 1, 2, and 3 years among the open cohort were significantly higher at 10.1, 17.0, and 20.5 %, compared to 5.7, 8.7, and 10.8 % in the laparoscopic cohort (p < 0.001). Similarly, small bowel obstruction was higher in the open compared to the laparoscopic group (open 10.4, 15.0, and 18.3 % vs. laparoscopic 2.7, 4.4, and 5.5 %, p < 0.001). Patients undergoing laparoscopic colorectal resection were less likely to develop ventral hernia [adjusted hazard ratio (AHR) 0.64 (95 % CI 0.52, 0.80); p < 0.0001] and small bowel obstruction [AHR 0.41 (95 % CI 0.31, 0.54); p < 0.0001].


The incidence of incisional ventral hernia and small bowel obstruction is significantly reduced in patients who undergo laparoscopic compared to open colorectal resection.


Laparoscopy Colorectal resection Colorectal surgery Colectomy Small bowel obstruction Ventral hernia 




Conflicts of interest

Daniel D. Klaristenfeld, MD, Bonnie H. Li, MS, Mohammad A. Abbass, MD, and Maher A. Abbas, MD declare that they have no conflicts of interest.

Elisabeth C. McLemore, MD—Honorarium for Speaking, Teaching, or Consulting for: Applied Medical, Covidien, Cubist, Ethicon Endosurgery, Genomic Health, Intuitive Surgical, Novadaq; Grant funding for surgical educational teaching course: Applied Medical, Covidien, Novatract, Stryker Endoscopy.

Financial support



  1. 1.
    Mudge M, Hughes LE (1985) Incisional hernia: a 10 year prospective study of incidence and attitude. Br J Surg 72(1):70–71CrossRefPubMedGoogle Scholar
  2. 2.
    Le HN, Mege D, Quaissi M, Sielezneff I, Sastre B (2012) Incidence and prevention of ventral incisional hernia. J Visc Surg 149(5):e3–e14CrossRefGoogle Scholar
  3. 3.
    Langer C, Kley C, Neufang T, Liersch T, Becker H (2001) Problem of recurrent incisional hernia after mesh repair of the abdominal wall. Chirurg 72(8):927–933CrossRefPubMedGoogle Scholar
  4. 4.
    Langer C, Liersch T, Kley C, Flosman M, Suss M, Siemer A, Becker H (2003) Twenty-five years of experience in incisional hernia surgery. A comparative retrospective study of 432 incisional hernia repairs. Chirurg 74(7):638–645CrossRefPubMedGoogle Scholar
  5. 5.
    Nieuwenhuijzen M, Reijnen MM, Kuijpers JH, van Goor H (1988) Small bowel obstruction after total or subtotal colectomy: a 10-year retrospective review. Br J Surg 85(9):1242–1245CrossRefGoogle Scholar
  6. 6.
    Beck DE, Opelka FG, Bailey R, Rauh SM, Pashos CL (1999) Incidence of small-bowel obstruction and adhesiolysis after open colorectal and general surgery. Dis Colon Rectum 42(2):241–248CrossRefPubMedGoogle Scholar
  7. 7.
    Ray NF, Denton WG, Thamer M, Henderson SC, Perry S (1998) Abdominal adhesiolysis: inpatient care and expenditures in the United States in 1994. J Am Coll Surg 186(1):1–9CrossRefPubMedGoogle Scholar
  8. 8.
    Funk LM, Perry KA, Narula VK, Mikami DJ, Melvin WS (2013) Current national practice patterns for inpatient management of ventral abdominal wall hernia in the United States. Surg Endosc 27(11):4104–4012CrossRefPubMedGoogle Scholar
  9. 9.
    Cassar K, Munro A (2002) Surgical treatment of incisional hernia. Br J Surg 89(5):534–545CrossRefPubMedGoogle Scholar
  10. 10.
    Forbes SS, Eskicioglu C, McLeod RS, Okrainec A (2009) Br J Surg 96(8):851–858CrossRefPubMedGoogle Scholar
  11. 11.
    Helgstrand F, Rosenberg J, Kehlet H, Strandfelt P, Bisgaard T (2012) Ann Surg 256(6):955–958CrossRefPubMedGoogle Scholar
  12. 12.
    Duron JJ, Silva NJ, du Montcel ST, Berger A, Muscari F, Hennet H, Veyrieres M, Hay JM (2006) Adhesive postoperative small bowel obstruction: incidence and risk factors of recurrence after surgical treatment. Ann Surg 244(5):750–757CrossRefPubMedCentralPubMedGoogle Scholar
  13. 13.
    Fleshman J, Sargent DJ, Green E et al (2007) For the clinical outcomes of surgical therapy study group. Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST study group trial. Ann Surg 246(4):655–664CrossRefPubMedGoogle Scholar
  14. 14.
    Jayne DG, Guillou PJ, Thorpe H et al (2007) UK MRC CLASSIC Trial Group. Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASSIC Trial Group. J Clin Oncol 25(21):3061–3068CrossRefPubMedGoogle Scholar
  15. 15.
    Jones OM, Stevenson AR, Clark D, Stitz RW, Lumley JW (2008) Laparoscopic resection for diverticular disease: follow-up of 500 consecutive patients. Ann Surg 248(6):1092–1097CrossRefPubMedGoogle Scholar
  16. 16.
    Schwandner O, Farke S, Fischer F, Eckmann C, Schiedeck TH, Bruch HP (2004) Langenbecks Arch Surg 389(2):97–103CrossRefPubMedGoogle Scholar
  17. 17.
    Weeks JC, Nelson H, Gelber S, Sargent D, Schroeder G (2002) Clinical outcomes of surgical therapy (COST) study group. Short-term quality-of-life outcomes following laparoscopic-assisted colectomy vs open colectomy for colon cancer: a randomized trial. JAMA 287(3):321–328CrossRefPubMedGoogle Scholar
  18. 18.
    Schwenk W, Haase O, Neudecker J, Muller JM (2005) Short term benefits for laparoscopic colorectal resection. Cochrane Database Syst Rev 20(3):CD003145Google Scholar
  19. 19.
    Kuhry E, Schwenk W, Gaupset R et al (2008) Long-term outcome of laparoscopic surgery for colorectal cancer: a cochrane systematic review of randomised controlled trials. Surg Endosc 22(9):2026–2029CrossRefGoogle Scholar
  20. 20.
    Bartels SA, Vlug MS, Hollmann MW, Dijkgraaf MG, Ubbink DT, Cense HA, van Wagensveld BA, Engel AF, Gerhards MF, Bemelman WA, Collaborative LAFA (2014) Study Group. Small bowel obstruction, incisional hernia and survival after laparoscopic and open colonic resection (LAFA study). Br J Surg 101(9):1153–1159CrossRefPubMedGoogle Scholar
  21. 21.
    Poylin V, Curran T, Lee E, Nagle D (2014) Laparoscopic colectomy decreases the time to administration of chemotherapy compared with open colectomy. Ann Surg Oncol 21(11):3587–3591CrossRefPubMedGoogle Scholar
  22. 22.
    Andersen LP, Klein M, Gögenur I, Rosenberg J (2007) Hernia after open versus laparoscopic sigmoid resection. Laparoendosc Adv Surg Tech A 17(5):604–607CrossRefGoogle Scholar
  23. 23.
    Rosin D, Zmora O, Hoffman A et al (2011) Incidence of adhesion-related bowel obstruction after laparoscopic colorectal surgery. Surg Endosc 25(12):3755–3760CrossRefGoogle Scholar
  24. 24.
    Schölin J, Buunen M, Hop W et al (2011) Bowel obstruction after laparoscopic and open colon resection for cancer: results of 5 years of follow-up in a randomized trial. Am J Surg 201(3):411–415CrossRefGoogle Scholar
  25. 25.
    Alvarez-Downing M, Klaassen Z, Orringer R et al (2011) Incidence of small bowel obstruction after laparoscopic and open colon resection. Am J Surg 201(3):411–415CrossRefPubMedGoogle Scholar
  26. 26.
    Reshef A, Hull TL, Kiran RP (2013) Risk of adhesive obstruction after colorectal surgery: the benefits of the minimally invasive approach may extend well beyond the perioperative period. J Am Coll Surg 197(2):177–181Google Scholar
  27. 27.
    Duepree HJ, Senagore AJ, Delaney CP, Fazio VW (2010) Does means of access affect the incidence of small bowel obstruction and ventral hernia after bowel resection? Laparoscopy versus laparotomy. Am J Surg 200(2):265–269CrossRefGoogle Scholar
  28. 28.
    Llaguna OH, Avgerinos DV, Lugo JZ et al (2010) Incidence and risk factors for the development of incisional hernia following elective laparoscopic versus open colon resections. Int J Surg 8(6):470–473CrossRefGoogle Scholar
  29. 29.
    Skipworth JR, Khan Y, Motson RW et al (2008) Incisional hernia rates following laparoscopic colorectal resection. Cancer Treat Rev 34(6):498–504CrossRefGoogle Scholar
  30. 30.
    Ihedioha U, Mackay G, Leung E, Molloy RG (2008) Laparoscopic colorectal resection does not reduce incisional hernia rates when compared with open colorectal resection. Surg Endosc 22(3):689–692CrossRefPubMedGoogle Scholar
  31. 31.
    Charlson ME, Pompei P, Ales KL, Mackenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383CrossRefPubMedGoogle Scholar
  32. 32.
    Simorov A, Shaligram A, Shostrom V, Boilesen E (2012) Laparoscopic colon resection trends in utilization and rate of conversion to open procedure: a national database review of academic medical centers. Ann Surg 256(3):462–468CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Daniel D. Klaristenfeld
    • 1
    Email author
  • Elisabeth C. McLemore
    • 2
  • Bonnie H. Li
    • 3
  • Mohammad A. Abbass
    • 4
  • Maher A. Abbas
    • 4
    • 5
  1. 1.Department of SurgeryKaiser PermanenteSan DiegoUSA
  2. 2.Kaiser Permanente, San Diego Medical CenterSan DiegoUSA
  3. 3.Research and EvaluationKaiser Permanente Southern CaliforniaPasadenaUSA
  4. 4.Cleveland ClinicClevelandUSA
  5. 5.Cleveland Clinic Abu DhabiAbu DhabiUnited Arab Emirates

Personalised recommendations