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Incisional and port-site hernias following robotic colorectal surgery

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Abstract

Background

The association between extraction site location, robotic trocar size, and the incidence of incisional hernias in robotic colorectal surgery remain unclear. Laparoscopic literature reports variable rates of incisional hernias versus open surgery, and variable rates of trocar site hernias. However, conclusions from these studies are confusing due to heterogeneity in closure techniques and may not be generalized to robotic cases. This study evaluates the effect of extraction site location on incisional hernia rates, as well as trocar hernia rates in robotic colorectal surgery.

Materials and methods

A retrospective review of multiport and single incision robotic colorectal surgeries from a single institution was performed. Patients underwent subtotal, segmental, or proctocolectomies, and were compared based on the extraction site through either a muscle-splitting (MS) or midline (ML) incision. Hernias were identified by imaging and/or physical exam. Demographics and risk factors for hernias were assessed. Groups were compared using a multivariate logistic regression analysis.

Results

The study included 259 colorectal surgery patients comprising 146 with MS and 113 with ML extraction sites. Postoperative computed tomograms were performed on 155 patients (59.8 %) with a mean follow-up of 16.5 months. The overall incisional hernia rate was 5.8 %. A significantly higher hernia rate was found among the ML group compared to the MS group (12.4 vs. 0.68 %, p < 0.0001). Of the known risk factors assessed, only increased BMI was associated with incisional hernias (OR 1.18). No trocar site hernias were found.

Conclusion

Midline extraction sites are associated with a significantly increased rate of incisional hernias compared to muscle-splitting extraction sites. There is little evidence to recommend fascia closure of 8-mm trocar sites.

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Authors and Affiliations

  1. Department of Surgery, The George Washington University Medical Center, 2150 Pennsylvania Ave, NW, Suite 6B, Washington, DC, 20037, USA

    Jeffrey N. Harr, Yen-Yi Juo, Samuel Luka, Samir Agarwal, Fred Brody & Vincent Obias

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  1. Jeffrey N. Harr
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  2. Yen-Yi Juo
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  3. Samuel Luka
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  4. Samir Agarwal
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  5. Fred Brody
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  6. Vincent Obias
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Correspondence to Vincent Obias.

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Disclosures

Dr. Obias is a consultant for Intuitive Surgical. Drs. Harr, Juo, Luka, Agarwal, and Brody have no conflicts of interest or financial ties to disclose.

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Harr, J.N., Juo, YY., Luka, S. et al. Incisional and port-site hernias following robotic colorectal surgery. Surg Endosc 30, 3505–3510 (2016). https://doi.org/10.1007/s00464-015-4639-2

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  • DOI: https://doi.org/10.1007/s00464-015-4639-2

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