High Rates of Incisional Hernia After Laparoscopic Right Colectomy With Midline Extraction Site

Abstract

Background: Laparoscopic surgery aims at reducing wound complications and improving cosmetics, among other advantages. High rates of postoperative ventral hernia (POVH) are observed after laparoscopic-assisted colectomies. Materials and Methods:In a 2011 to 2016 retrospective study of all patients at Rabin Medical Center, we examined POVH prevalence after right hemicolectomy for neoplasia and correlation to specimen extraction site. We also compared laparoscopic-assisted colectomy to hand-assisted laparoscopic colectomy. Included were patients who had postoperative abdominal computed tomography or magnetic resonance imaging scan as part of their routine oncological follow-up to 6 months postsurgery. Patients were excluded for conversion to laparotomy, and prior abdominal surgeries after right colectomy and before follow-up computed tomography/magnetic resonance imaging scan. Demographic and surgical data were collected from patient electronic records, and scans reviewed for POVH by a designated radiologist.Results: Of 370 patients, 138 (mean age 70.09 y, 58 males) were included: 54 (39.1%) were diagnosed with POVH, 42/72 (58.3%) at midline extraction site, and 12/66 (18.8%) at off-midline extraction sites (P < 0.0001). Surgical site infections and patients positive for tumor metastasis were associated with higher POVH rates. Most (74%) POVHs were identified within 18 months postsurgery (P < 0.0001). Body mass index, age, sex, diabetes mellitus, smoking, tumor size, lymph nodes positive for metastasis, and hand-assisted laparoscopic colectomy were not associated with POVH prevalence. Conclusion:High rates of radiologically diagnosed POVH were found after laparoscopic-assisted colectomy, with association to midline extraction site, surgical site infections, and positive tumor distant metastasis.

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

“…In 11% of cases ( n = 634, four studies), the indication for surgery was benign and, in this group, the estimated incidence of ESIH was 10.1% (95% CI [6.7%; 14.9%]) [5, 23, 33, 38]. In 39% of patients ( n = 5519, 14 studies) surgery was performed for malignancy and ESIH was estimated at 7.6% (95% CI [5.2%; 10.9%]) [15, 18, 22, 24, 26, 28–32, 40, 41, 46, 48]. Combined cohorts of benign and malignant underlying conditions comprised 50% of patients ( n = 5635, 18 studies) and the estimated ESIH incidence was 7.6% (95% CI [5.8%; 9.8%]) [4, 16, 17, 19–21, 25, 27, 34–37, 39, 42–47].…”

“…Transverse extraction was reported by 23 studies and the pooled incidence of ESIH was 5.2% (95% CI [3.5%; 7.5%], n = 3213) [4, 5,16, 20, 21, 24–26, 28, 31, 32, 35–44, 46, 48]. SSI was estimated at 6.0% (95% CI [3.8%; 9.4%], n = 1198) and seroma or haematoma was estimated at 4.0% (95% CI [1.8%; 9.0%], n = 160).…”

“…Three studies reported paramedian extraction and the pooled incidence of ESIH was estimated at 9.4% (95% CI [1.4%; 43.3%], n = 134) [31, 34, 42]. None of the studies reported on SSI, SSO or wound dehiscence.…”

“…For comparison of ESIH between midline (comprising midline and umbilical) and nonmidline (comprising transverse and paramedian) extraction, a total of 19 studies (two RCTs, four prospective cohorts, 13 retrospective cohorts, n = 7560) could be included [4, 16, 20, 21, 24,26, 31, 32, 34–37, 40–44, 46, 48]. As displayed in Figure 5, considering all study types, midline extraction was associated with a significantly higher risk for ESIH (OR 3.2, 95% CI [2.0; 5.3], p < 0.001, n = 7560) than nonmidline extraction.…”

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

“…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.…”