Raoul A Droeser, MD, Lawrence Lee, MD, PhD, Pepa Kaneva, MSc, Sender Liberman, MD, Patrick Charlebois, MD, Barry Stein, MD, Gerald M Fried, MD, Liane S Feldman, MD. Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre
Introduction: Observational studies suggest a higher incidence of incisional hernia with the use of midline compared to transverse extraction incisions after laparoscopic colon surgery. We report short-term outcomes of a randomized trial comparing transverse and midline extraction incisions focused on risk factors for the development of incisional hernia.
Methods: Between 2011 and May 2016, consenting patients undergoing laparoscopic colon resection for benign or malignant disease were randomly assigned to midline or transverse (muscle-splitting, lateral to rectus) specimen extraction site incision, stratified by right- and left-sided resections. Primary short-term endpoints included 30-day surgical site infection (SSI), average pain scores on postoperative days 0-2 (visual analog scale, 1-10), operating time, length of hospital stay and 30-day morbidity. All patients were managed using a standardized Enhanced Recovery Program. Analysis was by intention-to-treat. (Trial registration: NCT01247389).
Results: A total of 165 patients were randomized to midline (n=86) or transverse (n=79). Overall, 7 patients of the midline and 5 patients of the transverse group were converted to open, while 10 patients randomized to transverse underwent midline incision, and 1 patient randomized to midline underwent transverse incision. Baseline characteristics were similar including age, gender, diabetes, use of immunosuppression, body mass index and current smoking. There was no significant difference in the incidence of overall SSI (midline 7.0% vs transverse 7.6%; p=0.879), superficial SSI (4.7% vs 5.1%; p=0.902), or organ space SSI (2.3% vs 2.5%; p=0.931). Average pain scores on POD0-2 as well as the pain score trajectory over time were similar between both groups. There were no differences in the complications (midline 16.3% vs transverse 19%; p=0.933) or median [IQR] length of stay (midline 3 days [3-4] vs transverse 3 days [2-4]; p=0.145) between the two groups. Per-protocol analysis did not change these results.
Conclusions: In the short-term, there were no advantages to either midline or transverse specimen extraction incisions for laparoscopic colon surgery.
Funding: Canadian Surgical Research Fund
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79516
Program Number: P027
Presentation Session: Poster (Non CME)
Presentation Type: Poster