Short and long-term outcomes of a randomised controlled trial of vertical periumbilical wound versus transverse left iliac fossa wound for specimen retrieval in laparoscopic anterior resections
- 283 Downloads
The ideal incision for laparoscopic specimen extraction is not known. There has been no randomised study thus far evaluating extraction site in laparoscopic colorectal surgery. The aim of our study was to compare post-operative outcomes, pain scores and quality of life scores of vertical periumbilical (VW) versus transverse left iliac fossa (TW) incisions for specimen extraction in laparoscopic anterior resections.
Using an assumption of pain score of 5 in the VW group versus pain score of 2 in the TW group, on day one post-operatively, and based on a 80 % statistical power of analysis to achieve a statistical difference with reduction in pain scores, the sample size per arm calculated was 16. Forty patients undergoing laparoscopic anterior resection were randomised to VW (n = 20) or TW (n = 20). Primary endpoint was post-operative pain. Secondary endpoints were post-operative outcomes, wound cosmesis using Hollander Cosmesis Score and quality of life assessment using EQ-5D at 2 weeks and 2 months post-operatively.
Median pain score on the first post-operative day was 2 in both groups (p = 0.360). There was no significant difference in wound infection rates, operative time or post-operative recovery. Cosmesis scores and EQ-5D scores were also similar in both groups. At a median follow-up of 30 months, the incidence of extraction site incisional hernia was similar.
Transverse and vertical incisions in laparoscopic colorectal surgery have similar post-operative outcomes, with similar pain scores, cosmesis scores, quality of life scores and incisional hernia rates.
KeywordsLaparoscopic Colorectal Extraction site Wound complication Transverse incision Vertical incision
Dr. Wah-Siew Tan, Dr. Min-Hoe Chew, Dr. Kok-Sun Ho, Miss Juriyah Binte Yatim, Miss Joanne Siew-Foon Lai and Associate Professor Choong-Leong Tang have no conflicts of interest or financial ties to disclose.
- 4.Brown SR, Goodfellow PB (2005) Transverse verses midline incisions for abdominal surgery. Cochrane Database Syst Rev 19(4):CD005199Google Scholar
- 18.Kuhry E, Schwenk WF, Gaupset R, Romild U, Bonjer HJ (2008) Long-term results of laparoscopic colorectal cancer resection. Cochrane Database Syst Rev 16(2):CD003432Google Scholar
- 19.Sadava EE, Kerman Cabo J, Carballo FH, Bun ME, Rotholtz NA (2014) Incisional hernia after laparoscopic colorectal surgery. Is there any factor associated? http://www.ncbi.nlm.nih.gov/pubmed/24939160. Surg Endosc June 2014. Accessed 29 July 2014
- 21.Claes K, Beckers R, Heindryckx E, Kyle-Leinhase I, Pletinckx P, Claeys D, Muysoms F (2014) Retrospective observational study on the incidence of incisional hernias after colorectal carcinoma resection with follow-up CT scan. http://www.ncbi.nlm.nih.gov/pubmed/24445348. Hernia 2014. Accessed 5 October 2014