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

Navaratnam, AV; Ariyaratnam, Roshan; Smart, Neil J.; Parker, Michael; Rw, Motson; Arulampalam, T

doi:10.1308/003588414x14055925058274

Cited by 21 publications

(23 citation statements)

References 21 publications

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“…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. However, some studies [9,28] denoted that midline incision has a higher incisional hernia rate even when using the standardized technique for wound closure during laparoscopic colectomy.…”

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

confidence: 62%

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 Esupporting

confidence: 62%

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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“…This approach is associated with increased rates of IH compared to off-midline extractions sites, such as a Pfannenstiel incision. [9, 14, 17, 18] In our study, only 10% of R-RC and only 1 L-RC case were performed with alternative incisions and there were no IH in Pfannenstiel incisions. In addition, all Pfannenstiel incisions and the majority of other non-midline incisions were performed in the 11 patients undergoing intracorporeal anastomoses.…”

Section: Discussionmentioning

confidence: 52%

“…In a 2008 Cochrane review, only 2 trials reported IH rates after laparoscopic colectomy, and with significantly different results (4.7 and 23%). [11–14] Data regarding the IH rate after robotic colectomy are even sparser. In a recent meta-analysis of 6 R-RC versus L-RC trials, only 3 studies reported the IH rate; in a total of 70 R-RC patients, the IH rate was 1%.…”

Section: Discussionmentioning

confidence: 99%

Incisional hernias after laparoscopic and robotic right colectomy

Widmar

Keskin

Beltran

et al. 2016

Hernia

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Purpose Incisional hernia (IH) is a common complication after colectomy, with impacts on both healthcare utilization and quality of life. The true incidence of IH after minimally invasive colectomy is not well described. The purpose of this study was to examine the IH incidence after minimally invasive right colectomies (RC), and to compare the IH rate after laparoscopic (L-RC) and robotic (R-RC) colectomies. Methods This is a retrospective review of patients undergoing minimally invasive RC at a single institution from 2009–2014. Only patients undergoing RC for colonic neoplasia were included. Patients with previous colectomy or intraperitoneal chemotherapy were excluded. Three L-RC patients were included for each R-RC patient. The primary outcome was incisional hernia (IH) rate based on clinical examination or computed tomography (CT). Univariate and multivariate time-to-event analyses were used to assess predictors of IH. Results 276 patients where included, of which 69 had undergone R-RHC and 207 L-RHC. Patient and tumor characteristics were similar between the groups, except for higher tumor stage in L-RC patients. Both the median time to diagnosis (9.2 months) and the overall IH rate were similar between the groups (17.4% for R-RHC and 22.2% for L-RHC), as were all other postoperative complications. In multivariable analyses, the only significant predictor of IH was former or current tobacco use (HR 3.0, p=0.03). Conclusions This study suggests that the incidence of IH is high after minimally invasive colectomy, and that this rate is equivalent after R-RC and L-RC. Reducing the IH rate is an important opportunity for improving quality of life and reducing health care utilization after minimally invasive colectomy.

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“…This finding was further compounded by a study analysing ICA vs ECA following right colectomy in obese patients displaying a significant increase in incisional hernia rate in the ECA group. A study examining the standardization of specimen extraction in laparoscopic colorectal surgery reported an incisional hernia rate of 15.3% in patients with a transverse muscle splitting incision . Moreover, the authors reported an early return to gut function in patients with ICA.…”

Section: Discussionmentioning

confidence: 99%

Successful patient‐oriented surgical outcomes in robotic vs laparoscopic right hemicolectomy for cancer – a systematic review

et al. 2019

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Aim Minimally invasive surgical approaches for cancer of the right colon have been well described with significant patient and equivalent oncological benefits. Robotic surgery has advanced in its ability to provide multi-quadrant abdominal access, leading the surgical community to widen its application outside of the pelvis to other abdominal compartments. Globally it is being realized that a patient's surgical episode of care is becoming the epicentre of cancer treatment. In order to establish the role of robotic surgery in a patient's episode of care, 'successful patient-oriented surgical' parameters in right hemicolectomy for malignancy were measured. The objective was to examine the rates of successful patient-oriented surgical outcomes in robotic right hemicolectomy (RRH) compared to laparoscopic right hemicolectomy (LRH) for cancer.Methods A systematic search of MEDLINE (Ovid: 1946-present), PubMed (NCBI), Embase (Ovid: 1966-present) and Cochrane Library was conducted using PRISMA for parameters of successful patient-oriented surgical outcomes in RRH and LRH for malignancy alone. The parameters measured included postoperative ileus, anastomotic complication, surgical wound infection, length of stay (LOS), incisional hernia rate, conversion to open, margin status, lymph node harvest and overall morbidity and mortality.Results There were 15 studies which included 831 RRH patients and 3241 LRH patients, with a median age of 62-74 years. No study analysed the concept of successful patient-oriented surgical outcomes. There was no significant difference in the incidence of postoperative ileus, with less time to first flatus in RRH (2.0-2.7 days, compared with 2.5-4.0 days, P < 0.05).Anastomotic leak rate in one study reported a significant increase in LRH compared to RRH (P < 0.05, 0% vs 8.3%). Significantly decreased LOS following RRH was outlined in six studies. One study reported a significantly higher rate of incisional hernias following LRH with extracorporeal anastomoses compared to RRH with intracorporeal anastomoses. Overall rates of conversion to open surgery were less with RRH (0%-3.9% vs 0%-18%, P < 0.001, 0.05). One study outlined significantly higher rates of incomplete resection with an open right hemicolectomy compared with minimally invasive laparoscopic and robotic resections, with positive margin rates of 2.3%, 0.9% and 0% respectively (P < 0.001). Two studies reported significantly higher lymph node harvest in RRH (P < 0.05). Overall morbidity and 30-day mortality were comparable in both approaches.Conclusion Thirty-day morbidity and mortality were comparable between the two approaches, with patients undergoing RRH having lower anastomotic complications, increased lymph node harvest, and reduced LOS, conversion to open and incisional hernia rates in a number of studies. There are limited data on surgical approach and impact on quality of life and what patients deem successful surgical outcomes. There is a further need for a randomized controlled trial examining successful patient-oriented outco...

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

Cited by 21 publications

References 21 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

Incisional hernias after laparoscopic and robotic right colectomy

Successful patient‐oriented surgical outcomes in robotic vs laparoscopic right hemicolectomy for cancer – a systematic review

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