Jeffrey N Harr1, Yen-Yi Juo1, Samuel Luka1, Samir Agarwal1, Fred Brody1, Vincent Obias2. 1. Department of Surgery, The George Washington University Medical Center, 2150 Pennsylvania Ave, NW, Suite 6B, Washington, DC, 20037, USA. 2. Department of Surgery, The George Washington University Medical Center, 2150 Pennsylvania Ave, NW, Suite 6B, Washington, DC, 20037, USA. vobias@mfa.gwu.edu.
Abstract
BACKGROUND: The association between extraction site location, robotic trocar size, and the incidence of incisional hernias in robotic colorectal surgery remain unclear. Laparoscopic literature reports variable rates of incisional hernias versus open surgery, and variable rates of trocar site hernias. However, conclusions from these studies are confusing due to heterogeneity in closure techniques and may not be generalized to robotic cases. This study evaluates the effect of extraction site location on incisional hernia rates, as well as trocar hernia rates in robotic colorectal surgery. MATERIALS AND METHODS: A retrospective review of multiport and single incision robotic colorectal surgeries from a single institution was performed. Patients underwent subtotal, segmental, or proctocolectomies, and were compared based on the extraction site through either a muscle-splitting (MS) or midline (ML) incision. Hernias were identified by imaging and/or physical exam. Demographics and risk factors for hernias were assessed. Groups were compared using a multivariate logistic regression analysis. RESULTS: The study included 259 colorectal surgery patients comprising 146 with MS and 113 with ML extraction sites. Postoperative computed tomograms were performed on 155 patients (59.8 %) with a mean follow-up of 16.5 months. The overall incisional hernia rate was 5.8 %. A significantly higher hernia rate was found among the ML group compared to the MS group (12.4 vs. 0.68 %, p < 0.0001). Of the known risk factors assessed, only increased BMI was associated with incisional hernias (OR 1.18). No trocar site hernias were found. CONCLUSION: Midline extraction sites are associated with a significantly increased rate of incisional hernias compared to muscle-splitting extraction sites. There is little evidence to recommend fascia closure of 8-mm trocar sites.
BACKGROUND: The association between extraction site location, robotic trocar size, and the incidence of incisional hernias in robotic colorectal surgery remain unclear. Laparoscopic literature reports variable rates of incisional hernias versus open surgery, and variable rates of trocar site hernias. However, conclusions from these studies are confusing due to heterogeneity in closure techniques and may not be generalized to robotic cases. This study evaluates the effect of extraction site location on incisional hernia rates, as well as trocar hernia rates in robotic colorectal surgery. MATERIALS AND METHODS: A retrospective review of multiport and single incision robotic colorectal surgeries from a single institution was performed. Patients underwent subtotal, segmental, or proctocolectomies, and were compared based on the extraction site through either a muscle-splitting (MS) or midline (ML) incision. Hernias were identified by imaging and/or physical exam. Demographics and risk factors for hernias were assessed. Groups were compared using a multivariate logistic regression analysis. RESULTS: The study included 259 colorectal surgery patients comprising 146 with MS and 113 with ML extraction sites. Postoperative computed tomograms were performed on 155 patients (59.8 %) with a mean follow-up of 16.5 months. The overall incisional hernia rate was 5.8 %. A significantly higher hernia rate was found among the ML group compared to the MS group (12.4 vs. 0.68 %, p < 0.0001). Of the known risk factors assessed, only increased BMI was associated with incisional hernias (OR 1.18). No trocar site hernias were found. CONCLUSION:Midline extraction sites are associated with a significantly increased rate of incisional hernias compared to muscle-splitting extraction sites. There is little evidence to recommend fascia closure of 8-mm trocar sites.
Authors: A Coda; M Bossotti; F Ferri; R Mattio; G Ramellini; A Poma; F Quaglino; C Filippa; A Bona Journal: Surg Laparosc Endosc Percutan Tech Date: 2000-02 Impact factor: 1.719
Authors: R Sanz-López; C Martínez-Ramos; J R Núñez-Peña; M Ruiz de Gopegui; L Pastor-Sirera; S Tamames-Escobar Journal: Surg Endosc Date: 1999-09 Impact factor: 4.584
Authors: Jacobus W A Burger; Roland W Luijendijk; Wim C J Hop; Jens A Halm; Emiel G G Verdaasdonk; Johannes Jeekel Journal: Ann Surg Date: 2004-10 Impact factor: 12.969
Authors: Oscar Cano-Valderrama; Rodrigo Sanz-López; Gonzalo Sanz-Ortega; Rocío Anula; José L Romera; Mikel Rojo; Vanesa Catalán; José Mugüerza; Antonio J Torres Journal: Surg Endosc Date: 2020-06-15 Impact factor: 4.584
Authors: C Stabilini; M A Garcia-Urena; F Berrevoet; D Cuccurullo; S Capoccia Giovannini; M Dajko; L Rossi; K Decaestecker; M López Cano Journal: Hernia Date: 2022-01-11 Impact factor: 4.739
Authors: Adam D Shellito; Sonam Kapadia; Amy H Kaji; Cynthia M Tom; Christine Dauphine; Beverley A Petrie Journal: Surg Endosc Date: 2021-02-01 Impact factor: 4.584
Authors: Morris E Franklin; Robert K Cleary; Matthew Silviera; Tobi J Reidy; James McCormick; Craig S Johnson; Patricia Sylla; Jamie Cannon; Henry Lujan; Andrew Kassir; Ron Landmann; Wolfgang Gaertner; Edward Lee; Amir Bastawrous; Ovunc Bardakcioglu; Sushil Pandey; Vikram Attaluri; Mitchell Bernstein; Vincent Obias; Alessio Pigazzi Journal: Surg Endosc Date: 2021-11-01 Impact factor: 3.453
Authors: Robert K Cleary; Andrew Kassir; Craig S Johnson; Amir L Bastawrous; Mark K Soliman; Daryl S Marx; Luca Giordano; Tobi J Reidy; Eduardo Parra-Davila; Vincent J Obias; Joseph C Carmichael; Darren Pollock; Alessio Pigazzi Journal: PLoS One Date: 2018-10-24 Impact factor: 3.240