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Long-term abdominal wall benefits of the laparoscopic approach in liver left lateral sectionectomy: a multicenter comparative study

Surgical Endoscopy volume 35, pages 5034–5042 (2021)Cite this article

Abstract

Background

Laparoscopy is nowadays considered as the standard approach for hepatic left lateral sectionectomy (LLS), but its value in the prevention of incisional hernia (IH) has not been demonstrated.

Methods

Between 2012 and 2017, patients undergoing laparoscopic (LLLS) or open LLS (OLLS) in 8 centers were compared. Patients undergoing a simultaneous major abdominal procedure were excluded. The incidence of IH was assessed clinically and morphologically on computed tomography (CT) using inverse probability of treatment weighting (IPTW) and multivariable regression analysis.

Results

After IPTW, 84 LLLS were compared to 48 OLLS. Compared to OLLS, LLLS patients had reduced blood loss (100 [IQR: 50–200] ml vs. 150 [IQR: 50–415] ml, p = 0.023) and shorter median hospital stay (5 [IQR: 4–7] days vs. 7 [6–9] days, p < 0.001), but experienced similar rate of postoperative complications (mean comprehensive complication index: 12 ± 19 after OLLS versus 13 ± 20 after LLLS, p = 0.968). Long-term radiological screening was performed with a median follow-up of 27.4 (12.1–44.9) months. There was no difference between the two groups in terms of clinically relevant IH (10.7% [n = 9] after LLLS, 8.3% [n = 4] after OLLS, p = 0.768). The rate of IH detected on computed tomography was lower after LLLS than after OLLS (11.9% [n = 10] versus 29.2% [n = 14], p = 0.013). On multivariable analysis, the laparoscopic approach was the only independent factor influencing the risk of morphological IH (OR = 0.290 [95% CI: 0.094–0.891], p = 0.031). The 2 preferential sites for specimen extraction after LLLS were Pfannenstiel and midline incisions, with rates of IH across the extraction site of 2.3% [n = 1/44] and 23.8% [n = 5/21], respectively (p = 0.011).

Conclusion

The laparoscopic approach for LLS decreases the risk of long-term IH as evidenced on morphological examinations, with limited clinical impact. Pfannenstiel’s incision should be preferred to midline incision for specimen extraction after LLLS.

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Acknowledgements

This study was funded by a grant (PHRC AOM 11060) awarded by the French Ministry of Health.

Funding

This study was funded by a grant (PHRC AOM 11060) awarded by the French Ministry of Health.

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Authors and Affiliations

  1. Department of General Surgery and Liver Transplantation, Hôpital de La Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, 103 Grande Rue de la Croix-Rousse, 69317, Lyon Cedex 04, France

    Benjamin Darnis, Kayvan Mohkam, Mickaël Lesurtel & Jean-Yves Mabrut

  2. Cancer Research Center of Lyon, INSERM 1052/CNRS 5286 Unit, Lyon, France

    Kayvan Mohkam, Mickaël Lesurtel & Jean-Yves Mabrut

  3. Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital Paul Brousse, Villejuif, France

    Nicolas Golse, Eric Vibert & Daniel Cherqui

  4. Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital Beaujon, Clichy, France

    François Cauchy & Olivier Soubrane

  5. Department of Hepatobiliary Surgery, Centre Hospitalier Universitaire D’Amiens, Amiens, France

    Jean-Marc Regimbeau & Jeanne Dembinski

  6. Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital de La Timone, Marseille, France

    Jean Hardwigsen

  7. Department of Hepatobiliary Surgery and Liver Transplantation, Hôpitaux Universitaires de Strasbourg, Strasbourg, France

    Philippe Bachelier

  8. Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital Haut-Lévèque Bordeaux, Pessac, France

    Christophe Laurent

  9. Department of Hepatobiliary Surgery and Liver Transplantation, Centre Hospitalier Universitaire de Lille, Lille, France

    Stéphanie Truant, Guillaume Millet & Emmanuel Boleslawksi

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  1. Benjamin Darnis
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  2. Kayvan Mohkam
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  3. Nicolas Golse
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Contributions

The authors wish to express their gratitude to the following contributors to the present manuscript: Professor OF, Professor CD, Professor RA, Professor ASC, Doctor EG, Doctor J-PA, Doctor FF, Doctor PFA, Doctor SM and Doctor HGDs.

Corresponding author

Correspondence to Kayvan Mohkam.

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Disclosures

Drs Benjamin Darnis, Kayvan Mohkam, Nicolas Golse, Eric Vibert, Daniel Cherqui, François Cauchy, Olivier Soubrane, Jean-Marc Regimbeau, Jeanne Dembinski, Jean Hardwigsen, Philippe Bachelier, Christophe Laurent, Stéphanie Truant, Guillaume Millet, Mickaël Lesurtel, Emmanuel Boleslawksi, and Jean-Yves Mabrut have no conflict of interest or financial ties to disclose.

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Darnis, B., Mohkam, K., Golse, N. et al. Long-term abdominal wall benefits of the laparoscopic approach in liver left lateral sectionectomy: a multicenter comparative study. Surg Endosc 35, 5034–5042 (2021). https://doi.org/10.1007/s00464-020-07985-8

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  • DOI: https://doi.org/10.1007/s00464-020-07985-8

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