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01-04-2020 | Incision | Original Scientific Report

Laparoscopic Major Hepatectomy: Do Not Underestimate the Impact of Specimen Extraction Site

Authors: Théophile Guilbaud, Carlotta Feretti, Waclaw Holowko, Giovanni Maria Garbarino, Ugo Marchese, Anthony Sarran, Marc Beaussier, Brice Gayet, David Fuks

Published in: World Journal of Surgery | Issue 4/2020

Abstract

Background

In laparoscopic major hepatectomy, analysis of outcomes according to specimen extraction site remains poorly described. The aim was to compare postoperative outcomes according to specimen extraction site.

Methods

From 2000 to 2017, all laparoscopic major hepatectomies were reviewed and postoperative outcomes were analyzed according to specimen extraction site: subcostal (Group 1), midline (Group 2), or suprapubic (Group 3) incision.

Results

Among 163 patients, 15 (9.2%) belonged to Group 1, 49 (30.1%) in Group 2, and 99 (60.7%) in Group 3. The proportion of right-sided, left-sided, or central hepatectomies, mortality, and overall and severe complications were comparable between groups. Group 1 had larger tumors (61 vs. 38 vs. 47 mm; P = 0.014), higher operative time (338 vs. 282 vs. 260 min; P < 0.008), higher adjacent organ resection rate (46.6 vs. 16.3 vs. 7.1%; P < 0.001), and tended to increase pulmonary complications (40.0 vs. 12.2 vs. 18.2%; P = 0.064). In Group 2, a previous midline incision scar was more frequently used for specimen extraction site (65.3 vs. 26.6 and 30.3%, Group 1 and 3; P < 0.001). Postoperative incisional hernia was observed in 16.4% (n = 23) and was more frequent in Group 2 (26.6 vs. 6.6% and 10.1%, Group 1 and Group 3; P = 0.030). Finally, Group 2 (HR 2.63, 95% CI 1.41–3.53; P = 0.032) was the only independent predictive factor of postoperative incisional hernia.

Conclusions

While using a previous incision makes sense, the increased risk of postoperative incisional hernia after midline incision promotes the suprapubic incision.

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Title: Laparoscopic Major Hepatectomy: Do Not Underestimate the Impact of Specimen Extraction Site
Authors: Théophile Guilbaud
Carlotta Feretti
Waclaw Holowko
Giovanni Maria Garbarino
Ugo Marchese
Anthony Sarran
Marc Beaussier
Brice Gayet
David Fuks
Publication date: 01-04-2020
Publisher: Springer International Publishing
Keywords: Incision
Incisional Hernia
Published in: World Journal of Surgery / Issue 4/2020
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-019-05285-4

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Springer Medicine

Laparoscopic Major Hepatectomy: Do Not Underestimate the Impact of Specimen Extraction Site

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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