Skip to main content

Advertisement

SpringerLink
Log in

Does the extraction-site location in laparoscopic colorectal surgery have an impact on incisional hernia rates?

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Incisional hernias are a common postoperative complication with abdominal surgery. The major risk factors for their development include wound infection, obesity, and age. This study aimed to evaluate the impact of extraction-site location and technique on incisional hernia rates in laparoscopic colorectal surgery.

Methods

A prospective study of 208 consecutive patients who underwent laparoscopic colorectal surgery between March 2002 and July 2006 was performed. The study included only patients who had an extraction site on the abdominal wall. Patients were excluded if they were lost to follow-up evaluation or underwent conversion to open procedure. For the 166 patients included in the study, the mean follow-up period was 20.2 ± 14.4 months. Extraction-site incisions were classified into two groups: midline or off-midline. Midline wounds involved sharp division of the linea alba and were closed with a single layer of no.1 Vicryl. Off-midline incisions involved sharp division of the anterior and posterior sheaths with blunt spreading of the muscular layers and were closed in two layers with no. 1 Vicryl. Risk factors including wound infection, body mass index (BMI), age, and diabetes were analyzed.

Results

The incisional hernia rate for the entire series was 7.8%. The incisional hernia rate was 17.6% for the midline group (n = 74) and 0% for the off-midline group (n = 92) (p = 0.0002, statistically significant). There was no statistically significant difference in age, BMI, diabetes, follow-up time, or wound infection rate between the two groups.

Conclusion

In this series, the midline extraction site resulted in a significantly higher incisional hernia rate statistically than the off-midline extraction sites. The authors therefore have adopted an off-midline blunt muscle-splitting extraction site when performing laparoscopic colorectal surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Incisional hernias. North Penn Hernia Institute. Lansdale, Pennsylvania. http://www.hernia.tripod.com/incisional.html. Accessed 22 June 2006

  2. O’Dwyer PJ, Courtney CA (2003) Factors involved in abdominal wall closure and subsequent incisional hernia. Surg J R Coll Surg Edinb Ireland 1:17–22

    CAS  Google Scholar 

  3. Franklin ME Jr, Rosenthal D, Abrego-Medina D, Dorman JP, Glass JL, Norem R, Diaz A (1996) Prospective comparison of open vs laparoscopic colon surgery for carcinoma: five-year results. Dis Colon Rectum 39:S35–S46

    Article  PubMed  Google Scholar 

  4. Lacy AM, Garcia-Valdecasas JC, Delgado S, Castells A, Taurá P, Piqué JM, Visa J (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of nonmetastatic colon cancer: a randomised trial. Lancet 359:2224–2229

    Article  PubMed  Google Scholar 

  5. Liberman MA, Phillips EH, Carroll BJ, Fallas M, Rosenthal R (1996) Laparoscopic colectomy vs traditional colectomy for diverticulitis: outcome and costs. Surg Endosc 10:15–18

    Article  PubMed  CAS  Google Scholar 

  6. Milsom JW, Bohm B, Hammerhofer KA, Fazio V, Steiger E, Elson P (1998) A prospective, randomized trial comparing laparoscopic versus conventional techniques in colorectal cancer surgery: a preliminary report. J Am Coll Surg 187:46–54

    Article  PubMed  CAS  Google Scholar 

  7. Ramos JM, Beart RW Jr, Goes R, Ortega AE, Schlinkert RT (1995) Role of laparoscopy in colorectal surgery: a prospective evaluation of 200 cases. Dis Colon Rectum 38:494–501

    Article  PubMed  CAS  Google Scholar 

  8. Schwenk W, Bohm B, Witt C, Junghans T, Grundel K, Muller JM (1999) Pulmonary function following laparoscopic or conventional colorectal resection: a randomized controlled evaluation. Arch Surg 134:6–12

    Article  PubMed  CAS  Google Scholar 

  9. Schwenk W, Bohm B, Muller JM (1998) Postoperative pain and fatigue after laparoscopic or conventional colorectal resections: a prospective randomized trial. Surg Endosc 12:1131–1136

    Article  PubMed  CAS  Google Scholar 

  10. Schwenk W, Bohm B, Haase O, Junghans T, Muller JM (1998) Laparoscopic versus conventional colorectal resection: a prospective randomised study of postoperative ileus and early postoperative feeding. Langenbecks Arch Surg 383:49–55

    Article  PubMed  CAS  Google Scholar 

  11. Stocchi L, Nelson H, Young-Fadok TM, Larson DR, Ilstrup DM (2000) Safety and advantages of laparoscopic vs open colectomy in the elderly: matched-control study. Dis Colon Rectum 43:326–332

    Article  PubMed  CAS  Google Scholar 

  12. Weeks JC, Nelson H, Gelber S, Sargent D, Schroeder G (2002) Short-term quality-of-life outcomes following laparoscopic-assisted colectomy vs open colectomy for colon cancer: a randomized trial. JAMA 287:321–328

    Article  PubMed  Google Scholar 

  13. Berthou JC, Charbonneau P (1999) Elective laparoscopic management of sigmoid diverticulitis: results in a series of 110 patients. Surg Endosc 13:457–460

    Article  PubMed  CAS  Google Scholar 

  14. Brunt LM (2002) The positive impact of laparoscopic adrenalectomy on complications of adrenal surgery. Surg Endosc 16:252–257

    Article  PubMed  CAS  Google Scholar 

  15. Champault GG, Barrat C, Raselli R, Elizalde A, Catheline JM (2002) Laparoscopic versus open surgery for colorectal carcinoma: a prospective clinical trial involving 157 cases with a mean follow-up of 5 years. Surg Laparosc Endosc Percutan Tech 12:88–95

    Article  PubMed  Google Scholar 

  16. Degiuli M, Mineccia M, Bertone A, Pennazio M, Spandre M, Cavallero M, Calvo (2004) Outcome of laparoscopic colorectal resection. Surg Endosc 18:427–432

    Google Scholar 

  17. Duepree HJ, Senagore AJ, Delaney CP, Fazio VW (2003) Does means of access affect the incidence of small bowel obstruction and ventral hernia after bowel resection? Laparoscopy versus laparotomy. J Am Coll Surg 197:177–181

    Article  PubMed  Google Scholar 

  18. Franklin ME, Rosenthal D, Abrego-Medina D, Dorman JP, Glass JL, Norem R, Diaz A (1996) Prospective comparison of open vs laparoscopic colon surgery for carcinoma: five year results. Dis Colon Rectum 39:S35–S46

    Article  PubMed  Google Scholar 

  19. Lumley J, Stitz R, Stevenson A, Fielding G, Luck A (2002) Laparoscopic colorectal surgery for cancer: intermediate- to long-term outcomes. Dis Colon Rectum 45:867–874

    Article  PubMed  Google Scholar 

  20. Montgomery JS, Johnston K, Wolf JS (2005) Wound complications after hand-assisted laparoscopic surgery. J Urol 174:2226–2280

    Article  PubMed  Google Scholar 

  21. Vignali A, Braga M, Zuliani W, Frassion M, Radaelli G, Di Carlo V (2004) Laparoscopic colorectal surgery modifies risk factors for postoperative morbidity. Dis Colon Rectum 47:1686–1693

    Google Scholar 

  22. Kadar N, Reich H, Liu CY, Manko GF, Gimpelson R (1993) Incisional hernias after major laparoscopic gynecologic procedures. Am J Obstet Gynecol 5:1493–1495

    Google Scholar 

  23. Neshat C, Nezhat F, Seidman DS, Neshat C (1997) Incisional hernias after operative laparoscopy. J Laparoendosc Adv Surg Tech A 2:111–115

    Article  Google Scholar 

  24. Guillou PJ, Hall TJ, Donaldson DR, Broughton AC, Brennan TG (1980) Vertical abdominal incisions: a choice? Br J Surg 67:395–399

    Article  PubMed  CAS  Google Scholar 

  25. Kendall WH, Brennan G, Guillou J (1991) Suture length-to-wound length ratio and integrity of midline and lateral paramedian incisions. Br J Surg 78:705–707

    Article  PubMed  CAS  Google Scholar 

  26. Grantcharov TP, Rosenberg J (2001) Vertical compared with transverse incisions in abdominal surgery. Eur J Surg 167:260–267

    Article  PubMed  CAS  Google Scholar 

  27. Troxel SA, Das S (2005) Incisional hernia following hand-assisted laparoscopic surgery for renal cell cancer. JSLS 2:196–198

    Google Scholar 

  28. Winslow ER, Fleshman JW, Birnbaum EH, Brunt LM (2002) Wound complication of laparoscopic vs open colectomy. Surg Endosc 10:1420–1425

    Article  Google Scholar 

  29. Ihedioha U, Mackay G, Leung E, Molloy RG, O’Dwyer PJ (2007) Laparoscopic colorectal resection does not reduce incisional hernia rates when compared with open colorectal resection. Surg Endosc 22:689–692

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. The Centre for Minimal Access Surgery, North Bay General Hospital, 750 Scollard Avenue, North Bay, ON, Canada, P1B 5A4

    Ravinder Singh, Alex Omiccioli, Susan Hegge & Craig McKinley

  2. The Centre for Minimal Access Surgery, St. Joseph’s Hospital, 50 Charlton Street, Hamilton, ON, Canada, L8N 4A6

    Ravinder Singh & Craig McKinley

Authors
  1. Ravinder Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alex Omiccioli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Susan Hegge
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Craig McKinley
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ravinder Singh.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Singh, R., Omiccioli, A., Hegge, S. et al. Does the extraction-site location in laparoscopic colorectal surgery have an impact on incisional hernia rates?. Surg Endosc 22, 2596–2600 (2008). https://doi.org/10.1007/s00464-008-9845-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-008-9845-8

Keywords

Search

Navigation