The incidence of extraction site incisional hernia after minimally invasive colorectal surgery: a systematic review and meta‐analysis

Hartog, Floris den; Egmond, Sarah van; Poelman, Marijn; Menon, Anand; Kleinrensink, Gert-Jan; Lange, Johan F.; Tanis, Pieter J.; Deerenberg, Eva B.

doi:10.1111/codi.16455

Cited by 15 publications

(9 citation statements)

References 53 publications

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“…Suprapubic sites and peri‐umbilical sites were subsequently the next two most common extraction sites identified in this study. However, den Hartog et al's 24 meta‐analysis comparing common extraction sites in minimally invasive colorectal procedures demonstrated that nonmidline sites of extraction had significantly fewer incidence of incisional hernia compared with midline sites, without any difference in surgical site infection rates and Pfannenstiel remaining the superior choice in terms of decreased rate extraction site incisional hernia. Although, specimen extraction site can be influenced by a number of factors including anatomical limitations, surgeons' preference, and adherences near site.…”

Section: Discussionmentioning

confidence: 99%

Barriers to adopting intracorporeal anastomosis in colorectal procedures amongst Australian general surgeons

Patel,

Naseem

2024

Asian J Endoscop Surgery

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IntroductionMinimally invasive colonic anastomosis can be performed intracorporeally or extracorporeally with laparoscopic or robotic assistance. In colorectal surgery, choosing the optimal approach is still controversial. Mainly, the debate involves balancing the potential benefits of intracorporeal anastomosis (ICA) with increased technical difficultly with the more straightforward and widely accepted extracorporeal anastomosis (ECA). Both techniques require different skill sets, and this study aims to identify barriers that prevent adoption of ICA.MethodsA 31‐point questionnaire survey was distributed through the General Surgeons Australia (GSA) platform of active general surgeon in Australia. It was open for 2 months between July and August 2023. Statistical analysis was completed using descriptive analysis and logistic regression.ResultsForty‐three general surgeons completed the survey. ECA was the most performed and preferred surgical technique. It was identified that increased operative time is the biggest barrier to completing ICA followed by lack of training and no perceived benefit with ICA. Patient comorbidities did not result in choosing ICA over ECA; however, surgeons with less experience and volume in colorectal surgery were more likely complete ECA in operations with increased technical difficulty.ConclusionAlthough ECA is the go‐to technique for many Australian general surgeons, it is evident that they may be overlooking the benefits offered by ICA. Further training is required to improve operative times and confidence in the technique. Ongoing research, audits of existing techniques, and updated training will assist surgeons becoming acquainted with the latest evidence and to offer the best care to their patients.

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Section: Discussionmentioning

confidence: 99%

Barriers to adopting intracorporeal anastomosis in colorectal procedures amongst Australian general surgeons

Patel,

Naseem

2024

Asian J Endoscop Surgery

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“…Compared to alternative extraction sites, the Pfannenstiel incision is deemed superior owing to a much lower risk of incisional hernia [36][37][38]. The extent of the lymphadenectomy within the MIRH for colon cancer is currently a hot topic in the literature, however confusing.…”

Section: Discussionmentioning

confidence: 99%

National implementation of an optimal standardised technique for right-sided colon cancer: protocol of an interventional sequential cohort study (Right study)

et al. 2023

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Purpose Minimally invasive right hemicolectomy (MIRH) is the cornerstone of treatment for patients with right-sided colon cancer. This operation has evolved during recent decades, with many innovations and improvements but this has also resulted in high variability of uptake with subsequent substantial variableness. The aim of this ongoing study is to identify current surgical variations, determine the most optimal and standardised MIRH and nationally train and implement that technique to improve short-term clinical and long-term oncological outcomes. Methods The Right study is a national multicentre prospective interventional sequential cohort study. Firstly, current local practice was evaluated. Subsequently, a standardised surgical technique for right-sided colon cancer was determined using the Delphi consensus method, and this procedure was trained during hands-on courses. The standardised MIRH will be implemented with proctoring (implementation cohort), after which the performance will be monitored (consolidation cohort). Patients who will receive a minimally invasive (extended) right hemicolectomy for cT1-3N0-2M0 colon cancer will be included. The primary outcome is patient safety reflected in the 90-day overall complication rate according to the Clavien–Dindo classification. Secondary outcomes will include intraoperative complications, 90-day mortality rate, number of resected tumour-positive lymph nodes, completeness of mesocolic excision, surgical quality score, locoregional and distant recurrence and 5-year overall survival. A total number of 1095 patients (365 per cohort) will be included. Discussion The Right study is designed to safely implement the best surgical practice concerning patients with right-sided colon cancer aiming to standardise and improve the surgical quality of MIRH at a national level. Trial registration ClinicalTrials.gov: NCT04889456, May 2021.

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“…A recently published meta-analysis showed that the midline extraction site has a 16% incisional hernia rate compared to only 2.1% after the Pfannenstiel incision in minimally-invasive colorectal surgery. 46 In addition, the Pfannenstiel incision is associated with less pain, better cosmetic results, and less wound infection. 47 , 48 Only one study 31 reported the incisional hernia rate, as most studies did not provide complete long-term follow-up information.…”

Section: Discussionmentioning

confidence: 99%

Intracorporeal Versus Extracorporeal Colo-colic Anastomosis in Minimally-invasive Left Colectomy: a Systematic Review and Meta-analysis

Vaghiri,

Prassas,

Krieg

et al. 2023

Journal of Gastrointestinal Surgery

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Purpose The primary aim was to investigate the operative outcomes of intracorporeal (IA) and extracorporeal (EA) anastomosis in left-sided minimally-invasive colectomy. Methods A comprehensive literature search was conducted for studies comparing operative outcomes and follow-up data of IA versus EA in minimally-invasive left colectomy. Studies that investigated recto-sigmoid resections using transanal circular staplers were excluded. Data from eligible studies were extracted, qualitatively assessed, and included in a meta-analysis. Odds ratios (ORs) and mean differences with 95 per cent confidence intervals were calculated. Results Eight studies with a total of 750 patients were included (IA n = 335 versus EA n = 415). IA was associated with significantly lower overall morbidity (OR 0.40, 95% CI 0.26–0.61, p < 0.0001) and less frequent surgical site infection (SSI) (OR 0.27, 95% CI 0.12–0.61, p = 0.002) as primary outcomes compared to EA. Of the secondary outcomes, length of incision (SMD -2.51, 95% CI -4.21 to -0.81, p = 0.004), time to first oral diet intake (SMD -0.49, 95% CI -0.76 to -0.22, p = 0. 0004) and time to first bowel movement (SMD -0.40, 95% CI -0.71 to -0.09, p = 0.01) were significantly in favor of IA, while operative time was significantly shorter in the EA group (SMD 0.36, 95% CI 0.14–0.59, p = 0.001). Conclusions IA proves to be a safe and feasible option as it demonstrates benefits in terms of lower overall morbidity, fewer rates of SSI, smaller incision length, and faster postoperative gastrointestinal recovery despite a longer operative time compared to EA.

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The incidence of extraction site incisional hernia after minimally invasive colorectal surgery: a systematic review and meta‐analysis

Cited by 15 publications

References 53 publications

Barriers to adopting intracorporeal anastomosis in colorectal procedures amongst Australian general surgeons

Barriers to adopting intracorporeal anastomosis in colorectal procedures amongst Australian general surgeons

National implementation of an optimal standardised technique for right-sided colon cancer: protocol of an interventional sequential cohort study (Right study)

Intracorporeal Versus Extracorporeal Colo-colic Anastomosis in Minimally-invasive Left Colectomy: a Systematic Review and Meta-analysis

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