High Incidence of Symptomatic Incisional Hernia After Midline Extraction in Laparoscopic Colon Resection

Lawrence Lee, MD, Benjamin Mappin-kasirer, Chao Li, MD, Pepa Kaneva, MSc, Barry Stein, MD, Patrick Charlebois, MD, Sender Liberman, MD, Melina Vassiliou, MD, Gerald M Fried, MD, Liane S Feldman, MD. Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montreal, QC, Canada


Background: The incidence of incisional hernia (IH) has not decreased despite the use of laparoscopy for colon resections. After open abdominal surgery, off-midline incisions may result in fewer IH compared to midline laparotomy. The purpose of this study was to estimate the impact of the location of the incision used for specimen extraction on the incidence of IH after laparoscopic colon resection.

Methods: All laparoscopic segmental colectomies performed at a single university centre between 2005 and 2010 were identified from the operating room database and the medical records were reviewed. Cases involving the creation or reversal of a stoma were excluded. Patients were contacted by telephone for participation (IRB no. 10-183-SDR). Consenting patients completed the Body Image Questionnaire and were examined for specimen extraction site incisional hernia by a single surgeon who was not involved in the initial operation. Specimen extraction incisions were classified into midline, transverse and Pfannenstiel groups. Univariate analysis was performed using the χ2 and Fisher’s exact tests. A p < 0.05 was considered significant.

Results: Out of a total of 251 patients, 99 patients agreed to participate (68 midline, 7 transverse, and 24 Pfannenstiel), while 73 patients refused consent and 79 patients could not be contacted. Patients who refused consent were older (69.8 vs. 62.4 years, p = 0.001), but otherwise were similar to participants with respect to gender, malignant disease, postoperative complications and extraction site. Mean length of follow-up was 37.0 months in participants. Overall, 21% (21/99) of patients were diagnosed with an IH; 29% (20/68) of patients in the midline group developed an IH compared to 14% (1/7) in the transverse group and 0% (0/24) in the Pfannenstiel group (p = 0.002). 47% (10/21) of patients with IH (IH+) were symptomatic. The IH+ group had a lower cosmetic score (14.4 vs. 17.7, p = 0.02) compared to the IH- group, but no difference in body image score. There were no differences in body image and cosmetic scores between midline, transverse and Pfannenstiel groups.

Conclusions: There is a high incidence of symptomatic IH after midline specimen extraction in laparoscopic colectomy. Cosmesis is negatively impacted by the presence of IH. The rate of IH may be lower with the use of a transverse or Pfannenstiel incision for specimen extraction.

Session Number: Poster – Poster Presentations
Program Number: P283
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