Incidence of incisional hernia in the specimen extraction site for laparoscopic colorectal surgery: systematic review and meta-analysis

Lee, Lawrence; Abou-Khalil, Maria; Liberman, Sender; Boutros, Marylise; Fried, Gerald M.; Feldman, Liane S.

doi:10.1007/s00464-017-5573-2

Cited by 102 publications

(67 citation statements)

References 51 publications

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“…Although the incisional hernia rate in the SES in our study was higher than that reported in a previous study [25] of incisional hernia rate of approximately 10% in low midline or low transverse incision, it is presumed that the specimen of 50% or more of patients was extracted via the temporary stoma site, which may be a risk factor of incisional hernia after temporary stoma closure [25,26]. However, the comparable incisional hernia rates after LRCS between the two groups in our study was somewhat different from that reported in a systematic review [10], which reported that the incisional hernia rate in midline incision was three times higher than that in transverse incision. Because abdominal wound closure was mostly performed by attending surgeon in our institution, the similar incisional hernia rates in both groups in our study may be explained by the study of Navaratnam et al [27] who reported the incidence of incisional hernia is minimized even in midline incision using the standardized technique.…”

Section: A C C E P T E D a R T I C L Econtrasting

confidence: 88%

“…However, potential complications, such as incisional hernia, wound infection, and tumor seeding to the wound, may occur [2][3][4]. Although some studies have reported that low transverse and umbilical incisions as specimen extraction sites (SES) have similar incisional hernia and wound infection rates after laparoscopic colorectal surgery [5][6][7], low transverse incision is recommended because of its lower incisional hernia rate than midline incision [1][2][3][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

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Short-term and Medium-term Outcomes of Low Midline and Low Transverse Incisions in Laparoscopic Rectal Cancer Surgery

Kim

Shin

2020

Ann Coloproctol

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Limited data exist on the use of low midline and transverse incisions for specimen extraction or stoma sites in laparoscopic rectal cancer surgery (LRCS). We compared the short-term and medium-term outcomes of these incisions, and assessed whether wound complications of specimen extraction site (SES) are increased by specimen extraction through stoma site (SESS) in LRCS. Methods From March 2010 to December 2017, 189 patients who underwent LRCS and specimen extraction through low abdominal incisions were divided into two groups: midline (n=102) and transverse (n=87) groups, and perioperative outcomes were compared. Results The midline group showed higher the frequency of temporary stoma formation (p=0.001) and splenic flexure mobilization (p<0.001) than transverse group. The overall incisional hernia and wound infection rates in the SES were 21.6% and 25.5%, respectively, in the midline group and 26.4% and 17.2%, respectively, in the transverse group (p=0.494 and p=0.232, respectively). In patients who underwent SESS, the incisional hernia and wound infection rates of SES after stoma closure were 39.1% and 43.5%, respectively, in the midline group, and 35.5% and 22.6%, respectively, in the transverse group (p=0.840 and p=0.035, respectively). Conclusions In terms of incisional hernia and wound infection of SES, a low midline incision may be used as a low transverse incision in patients without temporary stoma in LRCS. However, considering the high wound complication rates after stoma closure in patients with SESS in this study, SESS would be performed with caution in LRCS.

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Section: A C C E P T E D a R T I C L Econtrasting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Short-term and Medium-term Outcomes of Low Midline and Low Transverse Incisions in Laparoscopic Rectal Cancer Surgery

Kim

Shin

2020

Ann Coloproctol

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“…For conventional laparoscopic colorectal operation, a small laparotomy in the abdomen is required for specimen harvested and colorectal anastomosis. Because of the mini-incision, it causes many undesirable outcomes such as incision pain, wound infection, scar, and even incision hernia, and the advantages of laparoscopic surgery are reduced [ 4 – 6 ]. To minimize those drawbacks, a novel surgical variant known as natural orifice specimen extraction (NOSE) surgery, with the features of natural orifice specimen extraction and total intraperitoneal anastomosis, has been introduced and is becoming a hotspot [ 7 – 10 ].…”

Section: Introductionmentioning

confidence: 99%

Meta-analysis of laparoscopic anterior resection with natural orifice specimen extraction (NOSE-LAR) versus abdominal incision specimen extraction (AISE-LAR) for sigmoid or rectal tumors

Yao

Wang

et al. 2020

World J Surg Onc

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Background Natural orifice specimen extraction surgery is a novel technique of minimally invasive surgery. The purpose of this study was to compare the safety of laparoscopic anterior resection with natural orifice specimen extraction (NOSE-LAR) and abdominal incision specimen extraction (AISE-LAR) for sigmoid or rectum tumors. Methods MEDLINE (PubMed), Embase, CENTRAL (Cochrane Central Register of Controlled Trials), Scopus, and ClinicalTrials databases were systematically searched for related articles up to August 2019. The primary outcomes included postoperative complications (overall postoperative complication, incision-related complication, anastomotic fistula, and severe complication) and pathologic results (lymph nodes harvested, proximal resection margin, and distal resection edge). The statistical analysis was performed on STATA 12.0 software. Results Ten studies comprising 1787 patients were used for meta-analysis. Compared with AISE-LAR, NOSE-LAR had more advantages in terms of overall postoperative complication (odds ratio (OR) = 0.65 (95% CI, 0.46 to 0.90; P = 0.01)), incision-related complication (OR = 0.13 (95% CI, 0.05 to 0.35; P < 0.01)), distal resection edge (weighted mean difference (WMD) = 0.17 cm (95% CI, 0.02 to 0.33 cm; P = 0.02)), recovery of gastrointestinal function (WMD = − 0.38 day (95% CI, − 0.70 to − 0.06 day; P = 0.02 )), pain scores in postoperative day 1 (WMD = − 1.64 (95% CI, − 2.31 to − 0.98; P < 0.01)), additional analgesics usage (OR = 0.21 (95% CI, 0.11 to 0.40; P < 0.01)) and hospital stay (WMD = − 0.71 day (95% CI, − 1.10 to − 0.32 day; P < 0.01)), while the operation time of NOSE-LAR was prolonged (WMD = 7.4 min (95% CI, 0.17 to 14.64 min; P = 0.04)). The anastomotic fistula, severe complication, lymph nodes harvested, proximal resection margin, intraoperative blood loss, and long-term outcomes in NOSE-LAR were comparable with AISE-LAR. Conclusions The safety of NOSE-LAR was demonstrated, and it could be an alternative to conventional surgery in laparoscopic anterior resection for sigmoid and rectal tumors. However, further randomized and multi-center trials are required.

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“…One other consideration if sub-fascial revision is required is the type of incision that is used. Data from colorectal surgery shows that incisional hernias are more common in vertical midline incisions than transverse or Pfannenstiel incisions ( 39 ). Furthermore, these patients may be at even higher risk of hernia due to having had a prior umbilical stoma that can create fascial weakness.…”

Section: Discussionmentioning

confidence: 99%

Long-term complications of continent catheterizable channels: a problem for transitional urologists

Hampson

Baradaran

Elliott³

2018

Transl. Androl. Urol.

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A majority of the transitional urology patient population have neurogenic bladder and many of these patients have undergone creation of continent catheterizable channels (CCCs) to facilitate bladder emptying. Transitional urologists will be faced with revision of these channels due to a variety of possible complications. We performed a comprehensive literature review to the data regarding the incidence, timing, and predisposing factors that lead to complications of CCCs as well as surgical revision techniques and their outcomes. Long-term channel complications and related revisions are common (25–30%) and likely underestimated. While many predictors for revision have been posited, the only predictor that has been significant in robust multivariable analysis is channel type, with appendicovesicostomies having a lower chance of requiring revision compared to Monti channels. Channels created in adults have high likelihood of requiring revision, even within a relatively short follow-up period. We review techniques for management of channel complications and their outcomes. As patients with congenital urologic conditions requiring CCCs are gaining longer lifespans, transitional urologists will be faced with revision and/or replacement of these channels. While some of these patients may require supravesical diversion in the future, data show that revision is feasible with good outcomes. Longer-term follow-up data is needed to understand the life-span and best practices of new CCCs created among the transitional population.

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Incidence of incisional hernia in the specimen extraction site for laparoscopic colorectal surgery: systematic review and meta-analysis

Abstract: Midline incisions for specimen extraction in laparoscopic colorectal surgery are at significantly higher risk of IH compared to off-midline (transverse or Pfannenstiel) incisions, but these data are of poor quality and heterogeneous.

Cited by 102 publications

References 51 publications

Short-term and Medium-term Outcomes of Low Midline and Low Transverse Incisions in Laparoscopic Rectal Cancer Surgery

Short-term and Medium-term Outcomes of Low Midline and Low Transverse Incisions in Laparoscopic Rectal Cancer Surgery

Meta-analysis of laparoscopic anterior resection with natural orifice specimen extraction (NOSE-LAR) versus abdominal incision specimen extraction (AISE-LAR) for sigmoid or rectal tumors

Long-term complications of continent catheterizable channels: a problem for transitional urologists

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