Incisional hernias after laparoscopic and robotic right colectomy

Abstract

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.

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

“…compared RRH with ICA and LRH with ECA, identifying a significantly higher rate of anastomotic leak ( P < 0.05) following LRH of 8.3% compared with 0% following RRH . Otherwise no other included study reported a difference between groups with a range of 0%–2.9% for RRH and 0%–10% for LRH . Megevand et al .…”

“…The incidence of postoperative ileus was reported in 10 studies with rates of 0%–12.4% and 0%–13% for RRH and LRH, respectively (Table ) . No study reported a significant difference between the robotic and laparoscopic approaches.…”

“… was the only study that compared ICA and extracorporeal anastomosis (ECA) in laparoscopic procedures, reporting postoperative ileus rates of 2.5% and 3.2%, respectively, with no significant difference between anastomotic techniques. While three studies contained robotic cohorts undergoing both ICA and ECA, no studies performed subset analysis comparing anastomotic techniques in robotic procedures . Median days to first flatus were also reported in 10 studies and four of these reported significantly fewer days to first flatus following RRH, between 2.0 and 2.7 days, compared with 2.5–4.0 days following LRH .…”

Laparoscopic‐endoscopic cooperative surgery for ileal lipoma: A case report

“…Furthermore, ileocecal resection requires a small abdominal incision to pull out the specimen and reconstruct the digestive tract, but several complications have been reported, including incisional hernia, wound infection, and adhesion relating to the small abdominal incision. The overall rate of incisional hernia after laparoscopic right colectomy reportedly ranges from 1.5% to 17.4% . Because the specimen is retrieved intraluminally through the anus during LECS, and mini‐laparotomy is unnecessary, the risk of those complications is estimated to be drastically reduced.…”

“…The overall rate of incisional hernia after laparoscopic right colectomy reportedly ranges from 1.5% to 17.4%. [7][8][9] Because the specimen is retrieved intraluminally through the anus during LECS, and mini-laparotomy is unnecessary, the risk of those complications is estimated to be drastically reduced.…”