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01-11-2012

High incidence of symptomatic incisional hernia after midline extraction in laparoscopic colon resection

Authors: Lawrence Lee, Benjamin Mappin-Kasirer, Alexander Sender Liberman, Barry Stein, Patrick Charlebois, Melina Vassiliou, Gerald M. Fried, Liane S. Feldman

Published in: Surgical Endoscopy | Issue 11/2012

Abstract

Background

The incidence of incisional hernia has not decreased despite the use of laparoscopy for colon resections. The objective of this study is to evaluate the impact of the incision used for specimen extraction on the incidence of incisional hernia after laparoscopic colectomy.

Methods

Patients who underwent laparoscopic colectomy without stoma at a single university tertiary-care centre from 2003 to 2009 were identified from an operating room database. Patients were contacted by telephone for participation, and underwent physical examination ± ultrasonography for incisional hernia at the specimen extraction site and completed the Body Image Questionnaire. Specimen extraction incisions were classified into midline, transverse and Pfannenstiel groups.

Results

Out of a total of 251 patients, 99 patients agreed to participate (68 midline, 7 transverse, 24 Pfannenstiel), while 73 patients refused consent and 79 patients could not be contacted. Patients who refused consent were older (69.8 vs 62.4 years, p = 0.001) but otherwise were similar to participants with respect to gender, malignant disease, postoperative complications and extraction site. Mean length of follow-up was 37.0 months. The overall incidence of incisional hernia was 21% (21/99), being 29 % (20/68) after midline incision compared with 14 % (1/7) after transverse and 0 % (0/24) after Pfannenstiel incisions (p = 0.002). Of patients with incisional hernia, 47 % (10/21) were symptomatic. Patients with incisional hernia had lower cosmetic score (14.4 vs 17.7, p = 0.02) compared with those without, but there was no difference in body image score. There were no differences in body image or cosmesis between the three incisions.

Conclusions

There is a high incidence of symptomatic incisional hernia after midline specimen extraction in laparoscopic colectomy, which negatively impacts cosmesis. The risk of hernia may be lower with the use of a transverse or Pfannenstiel incision for specimen extraction.

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Title: High incidence of symptomatic incisional hernia after midline extraction in laparoscopic colon resection
Authors: Lawrence Lee
Benjamin Mappin-Kasirer
Alexander Sender Liberman
Barry Stein
Patrick Charlebois
Melina Vassiliou
Gerald M. Fried
Liane S. Feldman
Publication date: 01-11-2012
Publisher: Springer-Verlag
Published in: Surgical Endoscopy / Issue 11/2012
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-012-2311-7

At a glance: The STEP trials

Springer Medicine

High incidence of symptomatic incisional hernia after midline extraction in laparoscopic colon resection

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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