Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Surgical Endoscopy
Published in: Surgical Endoscopy 4/2011

01-04-2011

Incisional hernia, midline versus low transverse incision: what is the ideal incision for specimen extraction and hand-assisted laparoscopy?

Authors: Ashwin deSouza, Bastian Domajnko, John Park, Slawomir Marecik, Leela Prasad, Herand Abcarian

Published in: Surgical Endoscopy | Issue 4/2011

Login to get access

Abstract

Background

Minimally invasive surgery is associated with smaller surgical incisions than those of traditional midline laparotomy. However, most colorectal resections and all hand-assisted procedures require an incision either for specimen retrieval or insertion of the hand-assist device. The ideal site of this incision has not been evaluated with respect to the incidence of incisional hernia. This study compares the rates of incisional hernia associated with a standard midline laparotomy, a midline incision of reduced length, and a Pfannenstiel incision.

Methods

From March 2004 to July 2007, 512 consecutive patients were identified from a prospectively maintained database according to predefined inclusion and exclusion criteria. Patients were divided into three groups depending on the type of incision (open, midline, and Pfannenstiel). Demographic variables, rate of incisional hernia, and risk factors for hernia were compared among the groups.

Results

There were 142, 231, and 139 patients in the open, midline, and Pfannenstiel groups, respectively. All three groups were comparable with respect to age, gender, steroid use, diabetes, number of patients with malignancy, and duration of follow-up. The Pfannenstiel group had a higher mean BMI (p = 0.015) and the open group had a higher rate of wound infection (28.2%) compared to the other groups. Incidence of incisional hernia was similar for the open and midline groups (19.7 and 16%, p = 0.36). At a mean follow-up of 17.5 months, not a single patient with a Pfannenstiel incision developed an incisional hernia (p < 0.001). BMI (p = 0.019), follow-up (p < 0.001), and Pfannenstiel incision (p < 0.001) were found to be predictors (protectors) of incisional hernia on multivariate analysis.

Conclusion

A Pfannenstiel incision is associated with the lowest rate of incisional hernia and should be the incision of choice for hand assistance and specimen extraction in minimally invasive colorectal resections wherever applicable.
Literature
1.
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 197:177–181PubMedCrossRef
2.
Laurent C, Leblanc F, Bretagnol F, Capdepont M, Rullier E (2008) Long-term wound advantages of the laparoscopic approach in rectal cancer. Br J Surg 95:903–908PubMedCrossRef
3.
Aalbers AGJ, Biere SSAY, van Berge Henegouwen MI, Bemelman WA (2008) Hand-assisted or laparoscopic-assisted approach in colorectal surgery: a systematic review and meta-analysis. Surg Endosc 22:1769–1780PubMedCrossRef
4.
Ringley C, Lee YK, Iqbal A, Bocharev V, Sasson A, McBride CL, Thompson JS, Vitamvas ML, Oleynikov D (2007) Comparison of conventional laparoscopic and hand-assisted oncologic segmental colonic resection. Surg Endosc 21(12):2137–2141PubMedCrossRef
5.
Nakajima K, Lee SW, Cocilovo C, Foglia C, Sonoda T, Milsom JW (2004) Laparoscopic total colectomy: hand-assisted vs standard technique. Surg Endosc 18(4):582–586PubMedCrossRef
6.
Marcello PW, Fleshman JW, Milsom JW, Read TE, Arnell TD, Birnbaum EH, Feingold DL, Lee SW, Mutch MG, Sonoda T, Yan Y, Whelan RL (2008) Hand-assisted laparoscopic vs. laparoscopic colorectal surgery: a multicenter, prospective, randomized trial. Dis Colon Rectum 51(6):818–826PubMedCrossRef
7.
Tjandra JJ, Chan MK, Yeh CH (2008) Laparoscopic vs. hand-assisted ultralow anterior resection: a prospective study. Dis Colon Rectum 51(1):26–31PubMedCrossRef
8.
Kang JC, Chung MH, Chao PC, Yeh CC, Hsiao CW, Lee TY, Jao SW (2004) Hand-assisted laparoscopic colectomy vs open colectomy: a prospective randomized study. Surg Endosc 18(4):577–581PubMedCrossRef
9.
Bucknall TE, Cok PJ, Ellis H (1982) Burst abdomen and incisional hernia: a prospective study of 1129 major laparotomies. Br Med J 284(6320):931–933CrossRef
10.
Mudge M, Hughes LE (1985) Incisional hernia: a ten year prospective study of incidence and attitudes. Br J Surg 72:70–71PubMedCrossRef
11.
Read RC, Yoder G (1989) Recent trends in management of incisional herniation. Arch Surg 124:485–488PubMed
12.
Santora TA, Rosalyn JJ (1993) Incisional hernia. Surg Clin North Am 73:557–570PubMed
13.
14.
Franchi M, Ghezzi F, Buttarelli M, Tateo S, Balestreri D, Bolis P (2001) Incisional hernia in gynecologic oncology patients: a 10-year study. Obstet Gynecol 97:696–700PubMedCrossRef
15.
Israelsson LA, Jonsson T (1994) Closure of midline laparotomy incisions with polydioxanone and nylon: the importance of suture technique. Br J Surg 81:1606–1608PubMedCrossRef
16.
Musella M, Milone F, Chello M, Angelini P, Jovino R (2001) Magnetic resonance imaging and abdominal wall hernias in aortic surgery. J Am Coll Surg 193:392–395PubMedCrossRef
17.
Seiler CM, Bruckner T, Diener MK, Papyan A, Golcher H, Seidlmayer C, Franck A, Kieser M, Büchler MW, Knaebel HP (2009) Interrupted or continuous slowly absorbable sutures for closure of primary elective midline abdominal incisions: a multicenter randomized trial (INSECT: ISRCTN24023541). Ann Surg 249(4):576–582PubMedCrossRef
18.
Wilson MS, Ellis H, Menzies D, Moran BJ, Parker MC, Thompson JN (1999) A review of the management of small bowel obstruction. Members of the Surgical and Clinical Adhesions Research Study (SCAR). Ann R Coll Surg Engl 81(5):320–328PubMed
19.
20.
Lauter DM, Froines EJ (2001) Initial experience with 150 cases of laparoscopic assisted colectomy. Am J Surg 181(5):398–403PubMedCrossRef
21.
Winslow ER, Fleshman JW, Birnbaum EH, Brunt LM (2002) Wound complications of laparoscopic vs open colectomy. Surg Endosc 16:1420–1425PubMedCrossRef
22.
Sonoda T, Pandey S, Trencheva K, Lee S, Milsom J (2009) Long-term complication of hand assisted versus laparoscopic colectomy. J Am Coll Surg 208:62–66PubMedCrossRef
23.
Halm JA, Lip H, Schmitz PI, Jeekel J (2009) Incisional hernia after upper abdominal surgery: a randomized controlled trial of midline versus transverse incision. Hernia 13:275–280PubMedCrossRef
24.
Grantcharov TP, Rosenberg J (2001) Vertical compared with transverse incisions in abdominal surgery. Eur J Surg 167:260–267PubMedCrossRef
25.
Singh R, Omiccioli A, Hegge S, McKinley C (2008) Does the extraction-site location in laparoscopic colorectal surgery have an impact on incisional hernia rates? Surg Endsoc 22:1596–2600
26.
Bruger JW, van’t Riet M, Jeekel J (2002) Abdominal incisions: techniques and postoperative complications. Scand J Surg 91:315–321
27.
Luijendijk RW, Jeekel J, Storm RK, Schutte PJ, Hop WC, Drogendijk AC, Huikeshoven FJ (1997) The low transverse Pfannenstiel incision and the prevalence of incisional hernia and nerve entrapment. Ann Surg 225(4):365–369PubMedCrossRef
28.
Biswas KD (1973) Why not Pfannenstiel’s incision? Obstet Gynecol 41:303–307PubMed
29.
de Groot HA, Jeeva MA, Gunston KD (1983) Morbidity after total abdominal hysterectomy. S Afr Med J 63:515–516
30.
Pietrantoni M, Parsons MT, O’Brien WF, Collins E, Knuppel RA, Spellacy WN (1992) Peritoneal closure or non-closure at cesarean. Obstet Gynecol 77:293–296CrossRef
31.
Hetzel H, Bichler A, Geir W, Dapunt O (1979) Sectio Caesarea: Pfannenstiel- oder Längsschnitt? Z Geburtshilfe Perinatol 183:128–135PubMed
32.
Daye SS, Barone JE, Lincer RM, Blabey RC, Smego DR (1993) Pfannenstiel syndrome. Am Surg 59:459–460PubMed
33.
Orr JW, Orr PJ, Holimon JL (1995) Radical hysterectomy: does the type of incision matter? Am J Obstet Gynecol 173:399–405PubMedCrossRef
34.
Redman JF, Barthold JS (1996) Experience with ileal augmentation cystoplasty using a short Pfannenstiel incision. J Urol 155:1726–1727PubMedCrossRef
Metadata
Title
Incisional hernia, midline versus low transverse incision: what is the ideal incision for specimen extraction and hand-assisted laparoscopy?
Authors
Ashwin deSouza
Bastian Domajnko
John Park
Slawomir Marecik
Leela Prasad
Herand Abcarian
Publication date
01-04-2011
Publisher
Springer-Verlag
Published in
Surgical Endoscopy / Issue 4/2011
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-010-1309-2

Other articles of this Issue 4/2011

Surgical Endoscopy 4/2011 Go to the issue

OriginalPaper

Reoperative antireflux surgery for dysphagia

OriginalPaper

Outcome of palliative self-expanding metal stent placement in malignant colorectal obstruction according to stent type and manufacturer

Letter

Reply to: Laparoscopic sleeve gastrectomy: a retrospective review of 1- and 2-year results. Surg Endosc 2010 (24):781–785

OriginalPaper

Laparoendoscopic single-site (LESS) retroperitoneal adrenalectomy using a homemade single-access platform and standard laparoscopic instruments

OriginalPaper

A comparative study of handsewn versus stapled gastrojejunal anastomosis in laparoscopic Roux-en-Y gastric bypass

Letter-Reply

Bupivacaine use with the Insuflow® device