Incidence of incisional hernia after laparoscopic liver resection

Wabitsch, Simon; Schulz, Philipp; Fröschle, F; Kästner, Anika; Fehrenbach, Uli; Benzing, Christian; Haber, Philipp; Denecke, Timm; Pratschke, Johann; Fikatas, Panagiotis; Schmelzle, Moritz

doi:10.1007/s00464-020-07475-x

Cited by 6 publications

(15 citation statements)

References 37 publications

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“…In that study, the use of a midline incision was associated with an increased risk of IH. Similar findings have been reported by Wabitsh et al in a study that mainly focused on laparoscopic minor hepatectomies [18]. Herein, we also found that among LLLS patients, most cases of IH occurred across a midline incision, either through an umbilical port scar or a midline incision used for specimen extraction.…”

Section: Discussionsupporting

confidence: 91%

“…While the OSLO-COMET trial demonstrated the value of laparoscopy in reducing severe postoperative morbidity [14], studies focusing on the value of laparoscopy for minor hepatectomies showed only modest benefits in terms of postoperative outcome, and no clear superiority in terms of severe morbidity [15,16]. Moreover, only two studies have focused so far on factors associated with long-term abdominal wall complications after laparoscopic liver resection, both of which were non-comparative studies including only laparoscopic hepatectomies [17,18]. While the expected benefit of laparoscopy seems obvious for major hepatectomies, which require large sized incisions, with substantial costal retraction, the value of the laparoscopic approach for LLS, which can be performed through a more limited incision, remains to be demonstrated.…”

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confidence: 99%

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Long-term abdominal wall benefits of the laparoscopic approach in liver left lateral sectionectomy: a multicenter comparative study

et al. 2020

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Background Laparoscopy is nowadays considered as the standard approach for hepatic left lateral sectionectomy (LLS), but its value in the prevention of incisional hernia (IH) has not been demonstrated. Methods Between 2012 and 2017, patients undergoing laparoscopic (LLLS) or open LLS (OLLS) in 8 centers were compared. Patients undergoing a simultaneous major abdominal procedure were excluded. The incidence of IH was assessed clinically and morphologically on computed tomography (CT) using inverse probability of treatment weighting (IPTW) and multivariable regression analysis. Results After IPTW, 84 LLLS were compared to 48 OLLS. Compared to OLLS, LLLS patients had reduced blood loss (100 [IQR: 50-200] ml vs. 150 [IQR: 50-415] ml, p = 0.023) and shorter median hospital stay (5 [IQR: 4-7] days vs. 7 [6-9] days, p < 0.001), but experienced similar rate of postoperative complications (mean comprehensive complication index: 12 ± 19 after OLLS versus 13 ± 20 after LLLS, p = 0.968). Long-term radiological screening was performed with a median follow-up of 27.4 (12.1-44.9) months. There was no difference between the two groups in terms of clinically relevant IH (10.7% [n = 9] after LLLS, 8.3% [n = 4] after OLLS, p = 0.768). The rate of IH detected on computed tomography was lower after LLLS than after OLLS (11.9% [n = 10] versus 29.2% [n = 14], p = 0.013). On multivariable analysis, the laparoscopic approach was the only independent factor influencing the risk of morphological IH (OR = 0.290 [95% CI: 0.094-0.891], p = 0.031). The 2 preferential sites for specimen extraction after LLLS were Pfannenstiel and midline incisions, with rates of IH across the extraction site of 2.3% [n = 1/44] and 23.8% [n = 5/21], respectively (p = 0.011). ConclusionThe laparoscopic approach for LLS decreases the risk of long-term IH as evidenced on morphological examinations, with limited clinical impact. Pfannenstiel's incision should be preferred to midline incision for specimen extraction after LLLS.

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Section: Discussionsupporting

confidence: 91%

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confidence: 99%

Long-term abdominal wall benefits of the laparoscopic approach in liver left lateral sectionectomy: a multicenter comparative study

et al. 2020

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“…In line with the results of Wabitsch and his colleagues, we also found that smoking status, diabetes, and the occurrence of postoperative complications were not associated with the development of an IH [ 10 ].…”

Section: Discussionsupporting

confidence: 90%

“…The rate of IH diagnosed by CT was 7.8% in our series. This favorably compares with the results of Wabitsch and his colleagues [ 10 ] in their newly published study. In their cohort of 18 patients who had undergone HALS for liver tumor, the incidence of IH was 22%.…”

Section: Discussionsupporting

confidence: 86%

The Role of Preoperative Platelet-to-Lymphocyte Ratio as a Predictor for Incisional Hernias after Hand-Assisted Laparoscopic Liver Surgery for Metastatic Colorectal Cancer

Mahamid

Abu-Zaydeh

Sawaied

et al. 2022

JPM

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(1) Background: Hand-assisted laparoscopic surgery for liver resection is a globally established technique. In this study, we report on the incidence and risk factors for postoperative incisional hernia (IH) after hand-assisted laparoscopic surgery for colorectal liver metastasis. (2) Methods: This was retrospective analysis of 89 consecutive hand-assisted laparoscopic surgery for colorectal liver metastasis. (3) Results: Participants were 39 females and 50 males. Median age was 65 years, and in 63%, the BMI was ≥25. Postoperative complications were encountered in 18% of the patients. Seven patients (7.8%) had postoperative incisional hernia in the hand port site. There was significantly higher incidence of incisional hernia in overweight patients (BMI ≥ 25) (p = 0.04), and in cases with simultaneous liver and colon resection (p = 0.02). In univariant and multivariant analyses, simultaneous liver and colon resection (p = 0.004 and 0.03, respectively), and platelet-to-lymphocyte ratio ≤ 200 (p = 0.03, 0.04, respectively) were both independent risk factors for developing postoperative incisional hernia. (4) Conclusions: Both simultaneous liver and colon resection, and platelet-to-lymphocyte ratio ≤ 200 are independent risk factors for postoperative incisional hernia after hand-assisted laparoscopic surgery for colorectal liver metastasis.

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“…Although use of minimally invasive surgery for distal pancreatectomy, including HALDP, is increasing nationally [14], few studies have compared outcomes between HALDP and LDP [15] and none compared the incidence of postoperative incisional hernia [9–11]. In our study, we hypothesized that HALDP would be associated with an increased risk of postoperative hernia compared to LDP and found a seven‐fold increase in the odds of developing postoperative incisional hernia with HALDP compared to LDP.…”

Section: Discussionmentioning

confidence: 89%

Hand‐Assisted Versus Pure Minimally‐Invasive Distal Pancreatectomy: Is There a Downside to Lending a Hand?

et al. 2022

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Background Hand‐assisted laparoscopic distal pancreatectomy (HALDP) is suggested to offer similar outcomes to pure laparoscopic distal pancreatectomy (LDP). However, given the longer midline incision, it is unclear whether HALDP increases the risk of postoperative hernia. Our aim was to determine the risk of postoperative incisional hernia development after HALDP. Methods We retrospectively collected data from patients undergoing HALDP or LDP at a single center (2012–2020). Primary endpoints were postoperative incisional hernia and operative time. All patients had at minimum six months of follow‐up. Outcomes were compared using unadjusted and multivariable regression analyses. Results Ninety‐five patients who underwent laparoscopic distal pancreatectomy were retrospectively identified. Forty‐one patients (43%) underwent HALDP. Patients with HALDP were older (median, 67 vs. 61 years, p = 0.02). Sex, race, Body Mass Index (median, 27 vs. 26), receipt of neoadjuvant chemotherapy, gland texture, wound infection rates, postoperative pancreatic fistula, overall complications, and hospital length‐of‐stay were similar between HALDP and LDP (all p > 0.05). In unadjusted analysis, operative times were shorter for HALDP (164 vs. 276 min, p < 0.001), but after adjustment, did not differ significantly (MR 0.73; 0.49–1.07, p = 0.1). Unadjusted incidence of hernia was higher in HALDP versus LDP (60% vs. 24%, p = 0.004). After adjustment, HALDP was associated with an increased odds of developing hernia (OR 7.52; 95% CI 1.54–36.8, p = 0.014). After propensity score matching, odds of hernia development remained higher for HALDP (OR 4.62; 95% CI 1.28–16.65, p = 0.031) p = 0.03). Conclusions Compared with LDP, HALDP was associated with increased likelihood of postoperative hernia with insufficient evidence that HALDP shortens operative times. Our results suggest that HALDP may not be equivalent to LDP.

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Incidence of incisional hernia after laparoscopic liver resection

Cited by 6 publications

References 37 publications

Long-term abdominal wall benefits of the laparoscopic approach in liver left lateral sectionectomy: a multicenter comparative study

Long-term abdominal wall benefits of the laparoscopic approach in liver left lateral sectionectomy: a multicenter comparative study

The Role of Preoperative Platelet-to-Lymphocyte Ratio as a Predictor for Incisional Hernias after Hand-Assisted Laparoscopic Liver Surgery for Metastatic Colorectal Cancer

Hand‐Assisted Versus Pure Minimally‐Invasive Distal Pancreatectomy: Is There a Downside to Lending a Hand?

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