Extraction site location and incisional hernias after laparoscopic colorectal surgery: should we be avoiding the midline?

Does transumbilical incision increase incisional hernia at the extraction site of laparoscopic anterior resection?

“…Several of them showed that midline incision had a risk of incisional hernia that was as high as that of open surgery and had a higher risk of incisional hernia than transverse resection or Pfannenstiel incision. [7][8][9] In this study, the risk of incisional hernia was similar between transumbilical incision and left lower transverse incision groups (1% vs 7%; P 5 .06), which was in contrast with the results of previous studies. It was similar to the results using multivariate analysis, including incision for extraction site, age, smoking, past history of respiratory disease, BMI, tumor size, follow-up for 2 or more years, and anastomotic leak.…”

“…Several of these studies reported that midline incision is associated with a higher risk of incisional hernia than other incisions. [7][8][9] Left lower transverse incision has been conventionally selected for laparoscopic sigmoid plus high and low anterior resection. Because transumbilical incision was reported to decrease surgical site infection, it spread widely.…”

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

“…This theory is supported by a study by Samia et al, who also found higher incisional hernia rates with midline incisions. 19 This group emphasised that a muscle splitting technique for the creation of the extraction site was key to reducing the incidence of hernia formation. Additionally, in the analysis of incisional hernia risk factors, they found that higher BMI was associated with increased incisional hernia rates.…”

Laparoscopic right hemicolectomy with intracorporeal versus extracorporeal anastamosis: a comparison of short-term outcomes

“…7,17,[21][22][23] Although not proven, the reason that muscle spreading, transverse fascial extraction incisions are less hernia prone is likely based on anatomic principles. First, spreading the rectus, transverse or oblique musculature in the direction of its fibres spares the blood supply as the incision runs parallel to the segmental arteries supplying them.…”

“…Although there are substantial data supporting the association between laparoscopic colorectal resections with transverse extraction sites and less hernia formation, these studies usually examine all colonic segments of resection. 7,22,23 With total colectomy, left-sided and rectal resections, the IA may be performed with a circular stapling device transanally to create an ileo-or colorectal anastomosis. In these cases, exteriorizing the bowel may be readi ly done through a transverse or Pfannenstiel incision.…”