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Left lower transverse incision versus Pfannenstiel-Kerr incision for specimen extraction in laparoscopic sigmoidectomy: a match pair analysis

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Objective

The ideal location of specimen extraction in laparoscopic-assisted colorectal surgery is still debatable.

Summary

The aim of this study was to compare the incidence of incisional hernias and surgical site infections in patients undergoing elective laparoscopic resection for recurrent sigmoid diverticulitis by performing specimen extraction through left lower transverse incision or Pfannenstiel-Kerr incision.

Methods

A total of 269 patients operated between January 2014 and December 2017 were retrospectively screened for inclusion in the study. Patients with specimen extraction through left lower transverse incision (LLT) and patients with specimen extraction through Pfannenstiel-K incision (P-K) were matched in 1:1 proportion regarding age, sex, comorbidities, and previous abdominal surgery. The incidence of incisional hernias and surgical site infections were compared by using Fisher’s exact test.

Results

After matching 77 patients in the LLT group and 77 patients in the P-K group, they were found to be homogenous regarding the above mentioned descriptive characteristics. No patients in the P-K group developed an incisional hernia compared with 10 patients (13%) in the LLT group (p = 0.001). All these patients required hernia repair with mesh augmentation. The rate of surgical site infections was 1/77 in the P-K group and 0/77 in the LLT group (p = 1.0). In the P-K group, a wound protector was used in 86% of patients whereas in the LLT group, 39% of the wounds were protected during specimen extraction (p < 0.0001).

Conclusion

The Pfannenstiel-Kerr incision may be the preferred extraction site compared with the left lower transverse incision given the significant reduction of the risk of incisional hernias.

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Author notes

  1. N. Varathan and N. Rotigliano contributed equally as co-first authors. D. C. Steinemann and A. Posabella also contributed equally as co-senior authors.

Authors and Affiliations

  1. University Center for Gastrointestinal and Liver Diseases, St Clara Hospital and University Hospital of Basel, Spitalstrasse 21, 4002, Basel, Switzerland

    N. Varathan, N. Rotigliano, F. Nocera, A. Tampakis, I. Füglistaler, M. von Flüe, D. C. Steinemann & A. Posabella

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  1. N. Varathan
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  2. N. Rotigliano
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  3. F. Nocera
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  4. A. Tampakis
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  5. I. Füglistaler
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  6. M. von Flüe
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  7. D. C. Steinemann
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  8. A. Posabella
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Contributions

All authors participated in the work in a fair, sufficiently, and appropriate way. In detail, Varathan N and Posabella A were the designers of the study, and Steinemann DC and Rotigliano N were the coordinators during all phases of the study.

Corresponding author

Correspondence to A. Posabella.

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Varathan, N., Rotigliano, N., Nocera, F. et al. Left lower transverse incision versus Pfannenstiel-Kerr incision for specimen extraction in laparoscopic sigmoidectomy: a match pair analysis. Int J Colorectal Dis 35, 233–238 (2020). https://doi.org/10.1007/s00384-019-03444-6

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  • DOI: https://doi.org/10.1007/s00384-019-03444-6

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