Oscar Cano-Valderrama1,2,3, Rodrigo Sanz-López4,5, Inmaculada Domínguez-Serrano4,5, Jana Dziakova4, Vanesa Catalán4, Mikel Rojo4, Mauricio García-Alonso4,5, José M Mugüerza4,5, Antonio J Torres4,5. 1. Department of Surgery, Hospital Universitario Clínico San Carlos, Madrid, Spain. oscarcanovalderrama@hotmail.com. 2. Department of Surgery, Universidad Complutense de Madrid, Madrid, Spain. oscarcanovalderrama@hotmail.com. 3. Department of Surgery, Hospital Universitario Clínico San Carlos, C/Profesor Martín Lagos SN, 28040, Madrid, Spain. oscarcanovalderrama@hotmail.com. 4. Department of Surgery, Hospital Universitario Clínico San Carlos, Madrid, Spain. 5. Department of Surgery, Universidad Complutense de Madrid, Madrid, Spain.
Abstract
BACKGROUND: Prophylactic mesh closure has only scarcely been studied to avoid extraction-site incisional hernia after laparoscopic colorectal surgery. The aim was to analyze extraction-site incisional hernia incidence after laparoscopic colorectal surgery to assess if prophylactic mesh closure should be studied. METHODS: A retrospective analytic cohort study was conducted in patients who had undergone laparoscopic colorectal surgery with an extraction-site incision. Extraction-site incisional hernia was diagnosed during clinical examination or imaging. Risk factors for extraction-site incisional hernia were analyzed. RESULTS: Two hundred and twenty-five patients were included. More than 80% of the patients had a malignant disease. Ninety-two patients (40.9%) underwent right colectomy. Midline extraction-site incision was used in 86 (38.2%) patients. After a mean follow-up of 2.4 years, 39 (17.3%) patients developed an extraction-site incisional hernia. Midline extraction-site incision was associated with incisional hernia when compared to transverse and Pfannenstiel incision (39.5% vs. 3.6%, OR 17.5, p < 0.001). Surgery to repair an extraction-site incisional hernia was also more frequent in the group of patients with a midline incision (10.5% vs. 1.4%, OR 8.0, p = 0.002). In the multivariate analysis, incisional hernia was associated with body mass index, high blood pressure, and midline incision. CONCLUSIONS: Extraction-site incisional hernia was mainly related to midline incisions; therefore, midline incision should be avoided whenever possible. Studying prophylactic mesh closure for Pfannesnstiel or transverse incisions is needless, as these incisions have a low incisional hernia risk.
BACKGROUND: Prophylactic mesh closure has only scarcely been studied to avoid extraction-site incisional hernia after laparoscopic colorectal surgery. The aim was to analyze extraction-site incisional hernia incidence after laparoscopic colorectal surgery to assess if prophylactic mesh closure should be studied. METHODS: A retrospective analytic cohort study was conducted in patients who had undergone laparoscopic colorectal surgery with an extraction-site incision. Extraction-site incisional hernia was diagnosed during clinical examination or imaging. Risk factors for extraction-site incisional hernia were analyzed. RESULTS: Two hundred and twenty-five patients were included. More than 80% of the patients had a malignant disease. Ninety-two patients (40.9%) underwent right colectomy. Midline extraction-site incision was used in 86 (38.2%) patients. After a mean follow-up of 2.4 years, 39 (17.3%) patients developed an extraction-site incisional hernia. Midline extraction-site incision was associated with incisional hernia when compared to transverse and Pfannenstiel incision (39.5% vs. 3.6%, OR 17.5, p < 0.001). Surgery to repair an extraction-site incisional hernia was also more frequent in the group of patients with a midline incision (10.5% vs. 1.4%, OR 8.0, p = 0.002). In the multivariate analysis, incisional hernia was associated with body mass index, high blood pressure, and midline incision. CONCLUSIONS: Extraction-site incisional hernia was mainly related to midline incisions; therefore, midline incision should be avoided whenever possible. Studying prophylactic mesh closure for Pfannesnstiel or transverse incisions is needless, as these incisions have a low incisional hernia risk.
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: Peter Tschann; Daniel Lechner; Paolo N C Girotti; Stephanie Adler; Stephanie Rauch; Jaroslav Presl; Tarkan Jäger; Philipp Schredl; Christof Mittermair; Philipp Szeverinski; Patrick Clemens; Helmut G Weiss; Klaus Emmanuel; Ingmar Königsrainer Journal: Langenbecks Arch Surg Date: 2022-01-23 Impact factor: 3.445