Incisional hernia, midline versus low transverse incision: what is the ideal incision for specimen extraction and hand-assisted laparoscopy?

Desouza, Ashwin; Domajnko, Bastian; Park, John; Marecik, Sławomir; Prasad, Leela M.; Abcarian, Herand

doi:10.1007/s00464-010-1309-2

Cited by 150 publications

(99 citation statements)

References 30 publications

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“…DeSouza et al performed a retrospective review of 512 patients comparing incisional hernia rates in open colorectal operations using standard midline incisions and handassisted laparoscopic colorectal operations that used midline and Pfannenstiel incisions for extraction sites. 17 They reported similar incisional hernia rates for the open and laparoscopic midline groups while no patients in the laparoscopic Pfannenstiel group developed incisional hernias. A review of 99 laparoscopic colectomies by Lee et al reported incisional hernia rates of 29%, 14% and 0% after specimen extraction through midline, transverse and Pfannenstiel incisions respectively.…”

Section: Discussionmentioning

confidence: 92%

Incisional hernia rate after laparoscopic colorectal resection is reduced with standardisation of specimen extraction

Navaratnam

Ariyaratnam

Smart

et al. 2015

annals

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INTRODUCTION Incisional hernia is a common complication of laparoscopic colorectal surgery. Extraction site may influence the rate of incisional hernias. Major risk factors for the development of incisional hernias include age, diabetes, obesity and smoking status. In this study, we investigated the effect of specimen extraction site on incisional hernia rate. METHODS Two cohorts of patients who underwent laparoscopic colorectal resections in a single centre in 2005 (n=85) and 2009 (n=139) were studied retrospectively. In 2005 all specimens were extracted through transverse muscle cutting incisions. In 2009 all specimens were extracted through midline incisions. Demographic variables, rate of incisional hernias and risk factors for hernia development were compared between the year groups. All patients had been followed up clinically for two years. RESULTS A total of 224 patients (mean age: 67.5 years, standard deviation: 16.35 years) were included in this study. Of these, 85 patients were in the 2005 transverse group and 139 were in the 2009 midline group. The total incisional hernia rate for the series was 8.0% at the two-year follow-up visit. For the 2005 group, the incisional hernia rate was 15.3% (n=13) and for the 2009 group, it was 3.6% (n=5) (p<0.01). The body mass index was higher in patients who developed incisional hernias than in those who did not (p=0.02). CONCLUSIONS The 2005 group had a significantly higher incisional hernia rate than the 2009 group. This is due to the differences in the incision technique and extraction site between the two groups.

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Section: Discussionmentioning

confidence: 92%

Incisional hernia rate after laparoscopic colorectal resection is reduced with standardisation of specimen extraction

Navaratnam

Ariyaratnam

Smart

et al. 2015

annals

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“…Mean patient age was 64.2 years (range 36-82), mean body mass index (BMI) was 25.2 (range [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33], and 75% were male. Mean tumor location was 6.4 cm from the AV (range 2-15, exact location reported in 41 cases).…”

Section: Notes Transanal Rectosigmoid Resection: Clinical Trialsmentioning

confidence: 99%

“…26 Additionally, hernia formation occurs in 3.6-24.3% of port sites after laparoscopic colorectal resection. [27][28][29][30][31][32][33] Thus, ongoing efforts have focused on developing strategies to minimize the need for sizeable abdominal incisions.…”

Section: Evolution Of the Surgical Management Of Rectal Cancermentioning

confidence: 99%

Transanal colorectal resection using natural orifice translumenal endoscopic surgery (NOTES)

Emhoff

Lee

Sylla

2013

Digestive Endoscopy

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The surgical management of rectal cancer has evolved over the past century, with total mesorectal excision (TME) emerging as standard of care. As a result of the morbidity associated with open TME, minimally invasive techniques have become popular. Natural orifice translumenal endoscopic surgery (NOTES) has been held as the next revolution in surgical techniques, offering the possibility of 'incisionless' TME. Early clinical series of transanal TME with laparoscopic assistance (n = 72) are promising, with overall intraoperative and postoperative complication rates of 8.3% and 27.8%, respectively, similar to laparoscopic TME. The mesorectal specimen was intact in all patients, and 94.4% had negative margins. There was no oncological recurrence in average-risk patients at short-term follow up, and 2-year survival rates in high-risk patients were comparable to that after laparoscopic TME. These preliminary studies demonstrate transanal NOTES TME with laparoscopic assistance to be clinically feasible and safe given careful patient selection, surgical expertise, and appropriate procedural training. We are hopeful that with optimization of transanal instruments and surgical techniques, pure transanal NOTES TME will become a viable alternative to open and laparoscopic TME in the future.

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“…Incision type is also an effective factor in hernia development. Many reports stated that transverse abdominal incisions have lower rate of incisional hernia when compared to midline incisions [12,13,14]. On the contrary , Ellis H et al [15] claimed that there were no difference for hernia development with different incision types.…”

Section: Discussionmentioning

confidence: 99%

The Surgical Results of Onlay Mesh Repair for Incisional Hernia

Kaya¹

2012

Ann Clin Anal Med

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Anahtar Kelimelerİnsizyonel Herni; Onlay Mesh Tamiri; Nüks Abstract Aim: İncisional hernia after abdominal surgery is an important problem. We aimed to evaluate the long-term recurrence rate as well as surgical complications in patients operated with onlay mesh repair technique for incisional hernia. Material and Method: We studied a serial of 139 patients retrospectively, operated due to incisional hernia in between January 2001 to November 2009 in Vakıf Gureba Training and Research Hospital General Surgery Department. The patient's age, sex, location and size of the defect, operation findings, duration of hospitalization, early and late complications and recurrences were recorded. Result: There were 56 men and 83 women in our serial. The mean age was 55 (age range, 30-85 years). The most common incisions that hernia had been developed were upper midline incision (51 patients) and lower midline incision (37 patients). The size of the hernia defect was 0-5 cm in 118 patients , 6-10 cm in 5 patients 11-15 cm in 12 patients, and above 15 cm in 4 patients. The postoperative complications were wound infection in 22 patients, seroma in 12 patients. The mean duration of hospital stay was 4.53 (range 1-10 days). The recurrence was detected in 6 patients. Discussion: It seems to be that onlay mesh repair is safe and effective technique for incisional hernia repair.

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Incisional hernia, midline versus low transverse incision: what is the ideal incision for specimen extraction and hand-assisted laparoscopy?

Abstract: A Pfannenstiel incision is associated with the lowest rate of incisional hernia and should be the incision of choice for hand assistance and specimen extraction in minimally invasive colorectal resections wherever applicable.

Cited by 150 publications

References 30 publications

Incisional hernia rate after laparoscopic colorectal resection is reduced with standardisation of specimen extraction

Incisional hernia rate after laparoscopic colorectal resection is reduced with standardisation of specimen extraction

Transanal colorectal resection using natural orifice translumenal endoscopic surgery (NOTES)

The Surgical Results of Onlay Mesh Repair for Incisional Hernia

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