High incidence of symptomatic incisional hernia after midline extraction in laparoscopic colon resection
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The incidence of incisional hernia has not decreased despite the use of laparoscopy for colon resections. The objective of this study is to evaluate the impact of the incision used for specimen extraction on the incidence of incisional hernia after laparoscopic colectomy.
Patients who underwent laparoscopic colectomy without stoma at a single university tertiary-care centre from 2003 to 2009 were identified from an operating room database. Patients were contacted by telephone for participation, and underwent physical examination ± ultrasonography for incisional hernia at the specimen extraction site and completed the Body Image Questionnaire. Specimen extraction incisions were classified into midline, transverse and Pfannenstiel groups.
Out of a total of 251 patients, 99 patients agreed to participate (68 midline, 7 transverse, 24 Pfannenstiel), while 73 patients refused consent and 79 patients could not be contacted. Patients who refused consent were older (69.8 vs 62.4 years, p = 0.001) but otherwise were similar to participants with respect to gender, malignant disease, postoperative complications and extraction site. Mean length of follow-up was 37.0 months. The overall incidence of incisional hernia was 21% (21/99), being 29 % (20/68) after midline incision compared with 14 % (1/7) after transverse and 0 % (0/24) after Pfannenstiel incisions (p = 0.002). Of patients with incisional hernia, 47 % (10/21) were symptomatic. Patients with incisional hernia had lower cosmetic score (14.4 vs 17.7, p = 0.02) compared with those without, but there was no difference in body image score. There were no differences in body image or cosmesis between the three incisions.
There is a high incidence of symptomatic incisional hernia after midline specimen extraction in laparoscopic colectomy, which negatively impacts cosmesis. The risk of hernia may be lower with the use of a transverse or Pfannenstiel incision for specimen extraction.
The authors thank Dr. Chao Li and Pepa Kaneva, MSc, for their help in the acquisition and analysis of the data.
The Steinberg Bernstein Centre for Minimally Invasive Surgery and Innovation is supported by an unrestricted educational grant from Covidien Canada. Dr. Liberman is a paid speaker and a surgical proctor for Covidien. Dr. Charlebois is on the advisory board for Merck. Dr. Fried receives research and fellowship funding from Covidien and research support from Olympus. Dr. Feldman receives research and fellowship funding from Covidien and research support from Ethicon. Drs. Lee, Stein, Vassiliou, and Mr. Mappin-Kasirer have no conflicts of interests or financial ties to disclose.
- 1.Schwenk W, Haase O, Neudecker J, Muller JM (2005) Short term benefits for laparoscopic colorectal resection. Cochrane Database Syst Rev CD003145Google Scholar
- 11.Kuhry E, Schwenk WF, Gaupset R, Romild U, Bonjer HJ (2008) Long-term results of laparoscopic colorectal cancer resection. Cochrane Database Syst Rev CD003432Google Scholar
- 22.Van’t Riet M, De Vos Van Steenwijk PJ, Bonjer HJ, Steyerberg EW, Jeekel J (2004) Incisional hernia after repair of wound dehiscence: incidence and risk factors. Am Surg 70:281–286Google Scholar
- 24.Desouza A, Domajnko B, Park J, Marecik S, Prasad L, Abcarian H (2010) Incisional hernia, midline versus low transverse incision: What is the ideal incision for specimen extraction and hand-assisted laparoscopy? Surg Endosc 24:1031–1036Google Scholar