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

Abstract

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.

Systematic review with meta-analysis of transverse vs. vertical midline extraction incisional hernia risk following laparoscopic colorectal resections

“…Eighteen retrospective trials ( 22 - 39 ), five prospective studies ( 40 - 44 ) and two RCTs ( 45 , 46 ) on 10,362 patients were included to conduct this meta-analysis based upon the principles provide by the Cochrane Collaboration. The PRISMA flow chart for trial selection is given in Figure 1 .…”

“…The PRISMA flow chart for trial selection is given in Figure 1 . The included trials were conducted in USA ( 22 , 23 , 27 , 30 , 35 , 36 , 41 , 44 , 46 ), Italy ( 24 ), Spain ( 25 , 40 ), Korea ( 26 , 31 , 34 , 43 ), Japan ( 28 , 37 ), Canada ( 32 , 33 , 45 ), Israel ( 29 , 42 ), Australia ( 38 ) and UK ( 38 , 39 ). The number of patients who were involved varies between the trials ranging between 33 ( 44 ) to 2,704 ( 26 ).…”

“…Eighteen retrospective trials (22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39), five prospective studies (40)(41)(42)(43)(44) and two RCTs (45,46) on 10,362 patients were included to conduct this meta-analysis based upon the principles provide by the Cochrane Collaboration.…”

Choice of specimen’s extraction site affects wound morbidity in laparoscopic colorectal cancer surgery

“…Wound morbidity is common following open or laparoscopic colorectal surgery with incidence of IH rates range from 5 to 15% and SSI (3-26%) with 10% incidence in elective laparoscopic colorectal resection [7,8,[11][12][13][14].…”

“…Although, the impact of specimen's extraction site on both SSI and IH has been evaluated in the literature [3][4][5][6][7][8], however, none of the studies have directly compared midline incision (MI) and suprapubic transverse incision (STI) as an extraction site following elective laparoscopic colorectal cancer resection.…”