Analysis of Outcomes by Extraction Site following Subtotal Colectomy in Ulcerative Colitis: A Retrospective Cohort Study

LaChapelle, Christopher R; Whitney, Stewart; Aalberg, Jeffrey; Plietz, Michael; Reppucci, Marina L.; Salk, Allison; Hwang, Songhon; Khaitov, Sergey; Greenstein, Alexander J.

doi:10.1007/s11605-019-04481-w

Cited by 6 publications

(19 citation statements)

References 19 publications

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“…A total of 15 studies reported Pfannenstiel extraction [4, 18, 22, 23, 27, 33, 35–40, 45–47]. The pooled incidence of ESIH was 2.1% (95% CI [1.2%; 3.6%], n = 1449) and SSI was estimated at 11.0% (95% CI [7.6%; 15.6%], n = 1064).…”

Section: Resultsmentioning

confidence: 99%

“…For comparative analysis of wound dehiscence, two studies (one prospective cohort, one retrospective cohort) were included, and no significant difference was found (OR 1.5, 95% CI [0.21; 11.2], p = 0.685, n = 1409) [4,24]. p = 0.845, n = 2809) [4,18,27,33,37,47]. No studies compared seroma or haematoma or wound dehiscence between these two groups.…”

Section: Cross-comparison Between Extraction Sitesmentioning

confidence: 99%

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The incidence of extraction site incisional hernia after minimally invasive colorectal surgery: a systematic review and meta‐analysis

et al. 2023

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Aim: Minimally invasive colorectal surgery reduces surgical trauma with better preservation of abdominal wall integrity, but the extraction site is still at risk of incisional hernia (IH). The aim of this study was to determine pooled incidence of IH for each type of extraction site and to compare rates of IH after midline, nonmidline and Pfannenstiel extraction.Method: A systematic review and meta-analysis was conducted using the PRISMA guidelines. Single-armed and multiple-armed cohort studies and randomized controlled trials regarding minimally invasive colorectal surgery were searched from five databases.Outcomes were pooled and compared with random-effects, inverse-variance models. Risk of bias within the studies was assessed using the Cochrane ROBINS-I and RoB 2 tool. Results: Thirty six studies were included, with a total 11,788 patients. The pooled extraction site IH rate was 16.0% for midline (n = 4081), 9.3% for umbilical (n = 2425), 5.2% for transverse (n = 3213), 9.4% for paramedian (n = 134) and 2.1% for Pfannenstiel (n = 1449). Nonmidline extraction (transverse and paramedian) showed significantly lower odds ratios (ORs) for IH when compared with midline extraction (including umbilical). Pfannenstiel extraction resulted in a significantly lower OR for IH compared with midline [OR 0.12 (0.50-0.30)], transverse [OR 0.25 (0.13-0.50)] and umbilical (OR 0.072 [0.033-0.16]) extraction sites. The risks of surgical site infection, seroma/haematoma or wound dehiscence were not significantly different in any of the analyses. Conclusion: Pfannenstiel extraction is the preferred method in minimally invasive colorectal surgery. In cases where Pfannenstiel extraction is not possible, surgeons should avoid specimen extraction in the midline.

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Section: Resultsmentioning

confidence: 99%

Section: Cross-comparison Between Extraction Sitesmentioning

confidence: 99%

The incidence of extraction site incisional hernia after minimally invasive colorectal surgery: a systematic review and meta‐analysis

et al. 2023

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“…Another study by LaChapelle et al compared midline, Pfannenstiel, and ostomy site extractions for patients undergoing subtotal colectomy for ulcerative colitis. 6 They found no difference in the rate of parastomal hernia between the three groups. On multivariate analysis, they did find that patients with a Pfannenstiel had a lower rate of incisional hernia, need for advanced ostomy nurse referral, or readmission.…”

Section: Extraction Through Ostomy Sitementioning

confidence: 92%

“…The incision can be extended laterally; however, this does increase the risk of damage or entrapment of the T12 subcostal, iliohypogastric, and ilioinguinal nerves. 5 6 This incision also creates a large potential space and can hide large hematomas resulting from unnoticed avulsion of perforating vessels during mobilization of the rectus sheath.…”

Section: Extraction Site Incisionsmentioning

confidence: 99%

Extraction Site in Minimally Invasive Colorectal Surgery

Paruch

2023

Clin Colon Rectal Surg

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The widespread adoption of minimally invasive colorectal surgery has led to improved patient recovery and outcomes. Specimen extraction sites remain a major source of pain and potential postoperative morbidity. Careful selection of the extraction site incision may allow surgeons to decrease postoperative pain, infectious complications, or rates of hernia formation. Options include midline, paramedian, transverse, Pfannenstiel, and natural orifice sites. Patient, disease, and surgeon-related factors should all be considered when choosing a site. This article will review different options for specimen extraction sites.

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“…Eighteen retrospective trials (22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39), five prospective studies (40)(41)(42)(43)(44) and two RCTs (45,46) on 10,362 patients were included to conduct this meta-analysis based upon the principles provide by the Cochrane Collaboration.…”

Section: Characteristics and Demographics Of Included Studiesmentioning

confidence: 99%

Systematic review with meta-analysis of transverse vs. vertical midline extraction incisional hernia risk following laparoscopic colorectal resections

Ahsan¹,

Nour²,

Peristeri³

et al. 2023

Transl Gastroenterol Hepatol

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Background: The aim of this article is to explore the risk of incisional hernia (IH) occurrence at the site of specimen extraction following laparoscopic colorectal resection (LCR), highlighting the comparison between transverse incision versus midline vertical abdominal incision.Methods: Analysis was conducted according to PRISMA guidelines. Systematic search of medical databases, EMBASE, MEDLINE, PubMed and Cochrane Library were performed to find all types of comparative studies reporting the incidence of IH at the specimen extraction site of transverse or vertical midline incision following LCR. The analysis of the pooled data was done using the RevMan statistical software.Results: Twenty-five comparative studies (including 2 randomised controlled trials) on 10,362 patients fulfilled the inclusion criteria. There were 4,944 patients in the transverse incision group and 5,418 patients in the vertical midline incision group. In the random effects model analysis, the use of transverse incision for specimen extraction following LCR reduced the risk of IH development (odds ratio =0.30, 95% CI: 0.19-0.49, Z=4.88, P=0.00001). However, there was significant heterogeneity (Tau 2 =0.97; Chi 2 =109.98, df=24, P=0.00004; I 2 =78%) among included studies. The limitation of the study is due to lack of RCTs, this study includes both prospective and retrospective studies along with 2 RCTs which makes the meta-analysis potentially biased in source of evidence.Conclusions: Transverse incision used for specimen extraction following LCR seems to reduce the risk of postoperative IH incidence compared to vertical midline abdominal incisions.

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Analysis of Outcomes by Extraction Site following Subtotal Colectomy in Ulcerative Colitis: A Retrospective Cohort Study

Cited by 6 publications

References 19 publications

The incidence of extraction site incisional hernia after minimally invasive colorectal surgery: a systematic review and meta‐analysis

The incidence of extraction site incisional hernia after minimally invasive colorectal surgery: a systematic review and meta‐analysis

Extraction Site in Minimally Invasive Colorectal Surgery

Systematic review with meta-analysis of transverse vs. vertical midline extraction incisional hernia risk following laparoscopic colorectal resections

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